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Personal Assistant Application Form Submission 

Title: Mr 

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): BSc in Computer Security 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Important qualities for a personal assistant working with a disabled person include empathy, effective communication, adaptability, respect for independence, patience, reliability, problem-solving skills, respect for privacy, physical fitness, cultural competence, relevant training, and maintaining professional boundaries. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I can contribute towards the needs and independence of a disabled person by providing empathetic support, fostering open communication, adapting to their unique requirements, and promoting their autonomy through respectful assistance. 

What is it about PA work which appeals to you? (required): As a personal assistant, the opportunity to provide meaningful support, make a positive impact on someones life, and contribute to their well-being appeals to me, fostering a sense of purpose and fulfillment. 

What are your hobbies/interests?:Travelling, cooking, football and camping 

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

Do you speak any other languages? (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): Monday, Thursday, Saturday and Sunday 

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.: 

Do you have portable DBS (which has been paid for and renewed for the current year)? (required): Yes/ 

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, Newport, and Swansea 

How many hours of work can you offer per week? (required): 72 

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