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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

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): Personal experience intaking care with my elderly nan. Also supporting and assisting personal family members with appointments and shopping etc. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Patient, supportive, understanding and caring 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Supporting and understanding individuals needs 

 
What is it about PA work which appeals to you? (required): Giving back to the community and learning each day 

 
What are your hobbies/interests?: Walking, shopping, sceneary 

 
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): Weekends only 

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

 
In what capacity do you know this person (should not be a family member)?  (required): . 


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?: 

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

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