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Personal Assistant Application Form Submission  

Title *: Miss. 

Town *: HENGOED 
County *: 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. *: 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 worked in the care sector for 12 years I have worked in different roles in the sector  

What qualities do you think are important when working as a personal assistant with a disabled person? *: kind,friendly and patience  

How do you think you can contribute towards the needs and the independence of a disabled person? *: Im very patient Im quite quiet so I feel I have a calming effect with others  

What is it about PA work which appeals to you? *: I enjoy helping others and helping them achieve their goals  

What are your hobbies/interests?: Bike riding,walking my dogs and watching tv  

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? *: Monday all day ,tuesday intill 3pm ,Wednesday all day and either Thursday or a Friday all day  

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

If you would like to expand on the answers given above? Please use the box below.: Cant do weekend due to looking after another gentleman And Tuesday evening  

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 agree that there is nothing which would prevent me from doing this job. *: No 

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?: Caerphilly Cardiff Vale of Glamorgan Blaenau  

How many hours of work can you offer per week?: 30 

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