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Personal Assistant Application Form Submission 

Title (required): Miss. 

Address 2: Whitchurch 
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): I have been a carer and support worker for 35 years. Currently working in supported living for 3 young adults. Prior to that have supported a 37 year young man with learning difficulties and autism, and a young lady 43…..and many many more. I am fully trained in social care level 2 have a recent dbs and first aid certificate, also registered with social care Wales and many many more. I 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Time, patience, understanding, empathy, I find it very rewarding. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I have worked with a variety of people of all ages who all required different levels of support. I have taken many to music, discos, art classes, trampolining, the gym, swimming. 

What is it about PA work which appeals to you? (required): The independence The working with one person where they get to know and trust you rather than have a team of strangers every time. 

What are your hobbies/interests?: Walking Cycling Gardening DIY Animals 

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): Fairly flexible, except a Sunday as I already work that day. 

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/ 
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 north preferably …..but may consider elsewhere. 

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/Tuesday AM/Tuesday PM/Tuesday Overnight/Wednesday AM/Wednesday PM/Wednesday Overnight/Thursday AM/Thursday PM/Thursday Overnight/Friday AM/Friday PM/Friday Overnight/Saturday AM/Saturday PM/ 
Further Information: