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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Town (required): Cardiff 

 
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 in a residential care home for two years. Within this time I trained in administration of medications & personal care. 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Understanding and compassion for the services users needs. To always treat the service user with respect and dignity. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Generosity, compassion and kindness. 

 
What is it about PA work which appeals to you? (required): I enjoy experiencing one to one with service user and feeling as if I will make a difference in their lives. 

 
What are your hobbies/interests?: I enjoy listening to music, art projects with my 5 year old daughter, swimming and long walks through the woods with my family. 

 
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): I don’t mind either days or nights. I worked both in the past. 

 
Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): 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? (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?: As I am not yet driving I will need to find places close to my area or within bus routes. Such as fairwater, Heath, Ely, canton, 

 
How many hours of work can you offer per week?: 16 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/ 
Further Information: