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Personal Assistant Application Form Submission 

 
Title (required): Mr. 

Address 2: Rhiwbina 
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): Health and social care level 2 Safeguarding level 2 Manual handling Extensive experience in a variety of healthcare and community settings ( schools, community, hospitals) 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Communication Listening skills Supporting to achieve goals Positivity Caring 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): By providing excellent support for the individual to achieve their goals, whilst ensuring they are safe and happy. A down to earth attitude and sense of humour helps build positive relationship. 

 
What is it about PA work which appeals to you? (required): Rewarding work, supporting and enabling people to access the community and carry out activities they wish to do 

 
What are your hobbies/interests?: Mainly sport ( football in particular), Enjoy watching films 

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

 
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 

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.: Other work commitments on Friday – Sunday 

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?: North cardiff 

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

 
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/ 

 
Further Information: Generally short shifts during the day, can do evenings from 7pm, nights available depending on finish time in the morning. Thursday available all afternoon /evening For right role I could be available on the weekend to replace current work commitments