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Personal Assistant Application Form Submission 

Title *: Mr. 

Town *: Barry 
County *: Vale of Glamorgan 

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. *: 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. *: QCF level 2 and 3 in health and social care, I have worked within the care industry for around 8 years, I have a vast range of experience from care home to domiciliary care. I have experience with young adults with learning disabilities, Adults with mental health, Nursing care, physical disabilities etc. 

What qualities do you think are important when working as a personal assistant with a disabled person? *: I believe the qualities that are important are, honesty, caring nature, Trustworthy, Reliable, life skills, patients and empathy 

How do you think you can contribute towards the needs and the independence of a disabled person? *: I have relevant care experience and life skills as well as qualifications and training to enable me to provide the best support i possibly can. 

What is it about PA work which appeals to you? *: The sense of getting to know and support the individual on a 1 to 1 basis. 

What are your hobbies/interests?: I enjoy spending time with family, friends and going on day trips at the weekend 

Would you consider a casual position if you are unsuccessful with this job? *: No 

Do you drive? *: Yes 
Are you a vehicle owner? *: Yes 
Do you smoke? *: Yes 

Are you able to undertake training? *: Yes 

What days/nights are you able to work, or prefer to work? *: Mon - Fri with occasional weekend 

Are there any circumstances which would prevent you from providing cover or swapping a shift? *: 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? *: No/ 
Please provide details if necessary: 

I agree that there is nothing which would prevent me from doing this job. *: Yes 

I consent to the above *: 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?: Vale of Glamorgan and Cardiff 

How many hours of work can you offer per week?: 40 

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