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Personal Assistant Application Form Submission 

 
Title (required): Mrs. 

Address 2: Gabalfa 
Town (required): Cardiff 

 
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 been caring for my mother in law for the past seven years. I am experienced in handling medication and assisting in medical appointments. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): I am experienced in looking after the elderly and i am very patient when doing tasks. 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I believe that i can do this by always being available on hand and trying to encourage the independence of someone who is disabled whilst assuring them that i am there. 

 
What is it about PA work which appeals to you? (required): I enjoy helping people and looking after them. I enjoy the company and getting to know new people. 

 
What are your hobbies/interests?: I enjoy spending time with my family and going out for walks. 

 
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): Preferably morning/afternoon shifts everyday 

 
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.: 

 
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?: 25 

 
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/Saturday AM/Sunday AM/ 
Further Information: