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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Address 2: Llanishen 

 
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 18 years experience in care I currently work for marie curie doing 12 shifts a month Im also employed with derwis looking after a gentleman doing 4 hours a week I feel I have enough experience for this role 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Patient Reliable Trust worthy Good communicator Being a good listener 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I can contribute by making sure the patient is independent as can be Listening to what needs the patient requires By having patience 

 
What is it about PA work which appeals to you? (required): One to one 

 
What are your hobbies/interests?: Travelling Walking and trekking Reading Swimming 

 
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): Nights 

 
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): No 
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?: All of Cardiff 

 
How many hours of work can you offer per week?: Depends if its nights 

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