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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Address 2: Pentrebane 
Town (required): Cardiff 
County (required): South 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. (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 was a Personal Care Assistant for a lady with m.s for over a year. • Assist with household finances-Bills, managing money, shopping online and paying staff • Help with self care- toileting bathing, dressing etc • Assist with ambulation and mobility needs • Muscle strengthening exercises • Dispense and administer meds • Provide support, encouragement and companionship 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): You need to be a patient ,caring and understanding person to be a good p.a. It’s important to be reliable and punctual to ensure the client is not let down as this can cause distress. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I am a bubbly, happy, friendly woman with lots of energy. I enjoy assisting and helping others an do so with care. I am reliable, honest an very hardworking. 

 
What is it about PA work which appeals to you? (required): I feel I have lots of qualities that fit well with pa work as I have previously done. I also enjoy helping and working with clients. 

 
What are your hobbies/interests?: I have 2 children so spend lots of time doing activities with them such as art and crafts, cinema, going to walks. When not doing these activities I like working out and gardening. 

 
Would you consider a casual position if you are unsuccessful with this job? (required): No 

 
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): Week days preferably 

 
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.: Childcare will have to be arranged in advance 

 
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, mainly fairwater side 

 
How many hours of work can you offer per week?: 10 

 
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/ 
Further Information: I would prefer day time block hours so I am able to arrange childcare.