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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Town (required): Cardiff 
County (required): Wales 

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’ve been a carer for almost 5 years. I love my job netting new people, as I’m a people’s person I love to build a relationship with my clients and help them through their daily needs. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Honest Trust worthy Reliable Friendly Caring 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Always encourage them to do what they can alone. Support them through daily things. 

 
What is it about PA work which appeals to you? (required): Personal care House work Laundry Meals Shopping Social 

 
What are your hobbies/interests?: Chatting Reading Watching tv Meeting new people 

 
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): Day 

 
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.: I’m a hardworking reliable individual. I am bubbly and get alone with everyone from all age groups. I don’t give up on people who can be challenging. I’m willing to go above and beyond for anyone 

 
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?: Cardiff 

 
How many hours of work can you offer per week?: 50 

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