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Personal Assistant Application Form Submission  

Title *: Mrs. 

Address 2: Roath  
Town *: 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. *: 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 as a support worker within a supported house, working with 3 ladies who had learning difficulties. For the past ten years I have worked as a self employed cleaner and home help, assisting with anything my customer requires, including cleaning, shopping, cooking, social visits, helping with phone calls. I have a mix of working professional customers and elderly customers. I also help care for my nan who is 95 and has vascular dementia.  

What qualities do you think are important when working as a personal assistant with a disabled person? *: I think being trustworthy and reliable is important. Patience and an understanding of the individual persons needs are important. Its crucial to respect that you are in somebodys home and act accordingly. Kindness, caring and an ability to adapt to different situations. Also respect confidentiality. I have a calm reassuring nature. I am a good listener.  

How do you think you can contribute towards the needs and the independence of a disabled person? *: I am very adaptable and happy to muck in with anything. I am patient, and have a good sense of humour. I believe we all have a right to live happy fulfilling lives, and will always do my best to support my client to achieve this, in whatever capacity they wish. I work hard, I am punctual and reliable. 

What is it about PA work which appeals to you? *: I have always enjoyed working with people, and helping people to live fulfilling lives and be part of the community in whatever way they wish. I enjoy meeting people, and that each day brings something different.  

What are your hobbies/interests?: I love disco music, reading Science fiction, baking, and watching Doctor Who with my son. I I organise our summer and Christmas street parties, and am a volunteer for Uniformed, a charity that helps low income families, by providing school uniform and sports kit.  

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? *: I am relatively flexible. I do have other jobs, some of which are set days, and some of which can be altered.  

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

Please provide details if necessary: I have a current DBS  

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. Penarth. Barry. 

How many hours of work can you offer per week?: Between 10 and 20 hours  

Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Monday Overnight/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/ 
Further Information: I am a driver, but I have a phobia of motorway driving and so will only drive in the areas previously specified.