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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

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): For the past 7 years I’ve worked as a care assistant both with children and elderly. I used to visit the service users in their residential houses and with children I used I picked them up from school with other care worker/s then take them for activities like walking out/park cinema, restaurant... 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Mentally strong, sense of humour, patience and strong personality. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Making them like easier, Maintaining dignity and independence and their personal space. 

 
What is it about PA work which appeals to you? (required): Honest, reliable, trustworthy 

 
What are your hobbies/interests?: Going out for exercise/walk, swimming and reading books. 

 
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): I am only applying this one as a have kids. I think I could do this one as I live in Butetown and I drive. 

 
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 can only work on days and not night as I do not have anyone to look after my kids at night. Since 2nd February 2019 I was doing 3 night shift 12 each at Bellavista Nursing Home but I went into on bank as I split up with my partner. 

 
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 never had any cautions or convictions. Never commented a crime. 

 
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?: Butetown, grangetown and canton. 

 
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/Sunday PM / 
Further Information: