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Personal Assistant Application Form Submission 

Title (required): Mr. 

Address 2: Ely 
Town (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): Worked for M&S for 30 years doing lots of different roles, and look after my wife for 5 years. Before she passed away. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): To respect their needs, dignity and to help with their needs 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I would like to bring them joy, independence and dignity 

What is it about PA work which appeals to you? (required): Over the years I have enjoyed looking after my wife , and found it very rewarding. Plus I will just like to give back to the community 

What are your hobbies/interests?: Like walking , gardening and films 

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): Yes 

Are you able to undertake training? (required): Yes 

What days/nights are you able to work, or prefer to work?  (required): Any days 

Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): No 

If you would like to expand on the answers given above? Please use the box below.: 

Please provide details if necessary: 37 years ago I have 5 criminal records . One for arson and 4 theft plus two years in young offenders and have a DBS 

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 

How many hours of work can you offer per week?: 25 

Please indicate the approximate times that you are available for work throughout the week.: Monday AM/Monday PM/Tuesday AM/Wednesday AM/Wednesday PM/Thursday AM/Thursday PM/Friday AM/Friday PM/Saturday AM/Saturday PM/Sunday AM/Sunday PM / 
Further Information: My past is over 37 years ago I am very reliable, honest, hardworking and a quick learner.