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Personal Assistant Application Form Submission 

 
Title (required): Mrs. 

Town (required): Llandaff North 
County (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 nursed and cared for my Mother who lived well into her 90s after suffering strokes and cancer. My young daughter (21) was diagnosed Cancer at a late stage and I have also nursed her and cared for her through her chemo and illness that this disease carrries. I am fully aware of care, empathy and just being there for someone at difficult and challenging times of their life 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Empathy, understanding and listening to the persons need and respect 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Listening to the person, catering for their needs to allow them to be independence and confident in all aspect of life 

 
What is it about PA work which appeals to you? (required): Caring and helping the person become more independent and confident with every day tasks 

 
What are your hobbies/interests?: Love of music, reading and meeting people. Long walks with my dog 

 
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): Can be flexible to suit Clients needs 

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

 
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: Not Applicable 

 
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?: North Cardiff 

 
How many hours of work can you offer per week?: 10 - 15 hours 

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