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Personal Assistant Application Form Submission 

Title (required): Miss. 
Address 2: Llanedeyrn 
Town (required): Cardiff 
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 am working two days a week with a lady with learning disabilities, I have also worked with an agency called New Directions I worked with faults with disabilities and cared for them in their homes. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Empathy, Trust and patience. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am a caring lady and love to help people 

What is it about PA work which appeals to you? (required): I have always worked in care work with adults and children and enjoy helping them knowing I have helped in their lives 
What are your hobbies/interests?: I enjoy reading romantic novels and walking especially in the woods, I love nature 

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): Days I am currently working are Tuesday, Thursday and some Sundays so another other days I am available, 

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

If you would like to expand on the answers given above? Please use the box below.: I occasionally have my grandchildren but my daughter is on furlow at the moment, Im working Tuesday and Thursday until March 

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?: Cardiff Blaenau Gwent 

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

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