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Personal Assistant Application Form Submission  

 
Title *: Mrs. 

Town *: Newport  
County *: Gwent 

 
I confirm that I have the right to work in the UK and am able to prove my eligibility status when required to do so. *: Yes 

 
Please read the Job Description carefully before providing information in this Section of the Application Form. Give details of your previous employment or experience which you think would help you to do this job. *: I have previously worked in a dementia home which was a challenging position. Residents occasionally got very uptight and stressed and confused. I am a very caring kind person and i was able to calm residents,distract them by offering a tea and biscuits which i found they always warmed to. I think a person that suffers with anxiety would need someone with a caring personal which i class myself as being. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? *: Your qualities are very important with a disabled person, you should be able to let the person put all their trust in you not feel embarrassed with personal care or if they get upset at times. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? *: I am quite willing to take the person wherever makes them happy and comfortable. I would obviously let them have there but of independence but would keep a close eye on them at all times 

 
What is it about PA work which appeals to you? *: I am interested in being a personal assistance because i enjoy helping people and chatting with them to cheer them up.  

 
What are your hobbies/interests?: I am interesting in going to penarth to enjoy a nice coffee and a look around the shops. I enjoy the theatre and eating out. 

 
Would you consider a casual position if you are unsuccessful with this job? *: Yes 

 
Do you drive? *: Yes 

 
Are you a vehicle owner? *: Yes 

 
Do you smoke? *: No 

 
Are you able to undertake training? *: Yes 

 
What days/nights are you able to work, or prefer to work? *: Would prefer not to work a Saturday due to helping my own mother with chores and shopping 

 
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: No 

 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: No/ 

 
Please provide details if necessary:  

 
I agree that there is nothing which would prevent me from doing this job. *: Yes 

 
I consent to the above *: Yes 

 
I agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes 

 
What geographical area’s are you able to cover?: Cardiff Newport  

 
How many hours of work can you offer per week?: 10 

 
Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Tuesday PM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Sunday AM/Sunday PM / 
Further Information: