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Personal Assistant Application Form Submission 

Title (required): Miss. 

Address 2: Tonteg 
Town (required): Pontypridd 

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 currently work in a secondary specialist resource base. I work with pupils from age 11 to 18/19 

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

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am enthusiastic, and willing to get to know the persons needs and help them work towards their independence. 

What is it about PA work which appeals to you? (required): I enjoy meeting new people and helping others to for fill and enjoy their lives. 

What are your hobbies/interests?: I enjoy socialising , meeting new people, reading, theatre, cinema, I play skittles weekly and enjoy a Zumba class. 

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): Mon to Friday from 4pm term time. Flexible weekends 

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 have worked in my current job for over 10 years, with a vast understanding of most disabilities. I am first aid trained and an Emotional Literacy Support Assistant. 

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?: Rhondda /Cardiff 

How many hours of work can you offer per week?: 6/8 hours 

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