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Personal Assistant Application Form Submission 

 
Title (required): Mr. 

Town (required): Cardiff 
County (required): South Glamorgan 

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. (required): 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. (required): I have worked as a PA with Dewis over two years with two different services users One being community based which is exactly the same as the job role described 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Reliable Trustworthy Talkative 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I give service user a voice by letting them take charge of choose what they want to do 

 
What is it about PA work which appeals to you? (required): I find it beneficial to help people who are in need 

 
What are your hobbies/interests?: Any type of sport Going to the gym Watching tv Walking Cinema 

 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 

 
Do you drive? (required): Yes 
Are you a vehicle owner?  (required): Yes 
Do you smoke? (required): No 

 
Are you able to undertake training? (required): Yes 

 
What days/nights are you able to work, or prefer to work?  (required): Evenings after 4:30 

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

 
If you would like to expand on the answers given above? Please use the box below.: 

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

 
Please provide details if necessary: 

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

 
I consent to the above (required): 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 

 
How many hours of work can you offer per week?: Maximum 13 hours 

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