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Personal Assistant Application Form Submission 

Title (required): Mr. 

Address 2: Senghenydd 
Town (required): Caerphilly 

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 (and currently still work with some) with a number of people with disabilities. Ranging from cerebral palsy, visual impairment and autism. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Reliable, empathy, and willingness to listen and learn. I think these are most important. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I have experience in supporting people with disabilities out in the community. Such as helping to guide a visually impaired person around a bingo hall, or helping someone with autism socially when visiting a coffee shop or supermarket. 

What is it about PA work which appeals to you? (required): I have done it for a few years now, and I have never looked back. I like to help people and have been lucky enough, that everyone I have worked with have been fair and pleasant to worth with. 

What are your hobbies/interests?: I like to spend time with my two young daughters in my spare time. When I get time for myself I like to play guitar and watch movies. 

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): Tuesday, Wednesday and Thursday daytime. 

Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): Yes 

If you would like to expand on the answers given above? Please use the box below.: I work part-time on a Monday and Tuesday, aswell as some evenings. I also have to young daughters to consider when making last minute changes to routine. 

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/ 

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?: Roughly between Cardiff and Merthyr Tydfil. 

How many hours of work can you offer per week?: 12 

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