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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Address 2: st mellons 
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 have worked for pro care l have experience and l know all about dementia 

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

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Help people with disabilities and help them much as l can 

 
What is it about PA work which appeals to you? (required): I like to help people lam a very helpful person and kind 

 
What are your hobbies/interests?: I like to go to the gym lam a very fit female 

 
Would you consider a casual position if you are unsuccessful with this job? (required): Yes 

 
Do you drive? (required): No 
Are you a vehicle owner?  (required): No 
Do you smoke? (required): Yes 

 
Are you able to undertake training? (required): Yes 

 
What days/nights are you able to work, or prefer to work?  (required): I can work days or nights 

 
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): No 

 
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?: St mellons llanrumney 

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

 
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/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/ 
Further Information: Any hours any days