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Personal Assistant Application Form Submission 

 
Title (required): Mr. 

Address 2: Caerau 
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): NVQ Level 2 Health and Social Care 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Patients, empathy, commitment and a friendly personality. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): By being a support when required, also knowing when to give the client their personal space and still encourage them to fulfill their maximum potential. 

 
What is it about PA work which appeals to you? (required): Working one to one means really getting to know the client, where as in a care home setting you dont really get time to really chat to clients and interact. 

 
What are your hobbies/interests?: Spending time with family and friends, watching movies, boxing, taekwondo and collecting star wars memorabilia. 

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

 
Do you drive? (required): No 
Are you a vehicle owner?  (required): No 
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): Available for all 

 
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?: Any 

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

 
Further Information: I am a kind and caring person that is experienced in all aspects of health and social care and dedicated to delivering the best possible care I can give.