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Personal Assistant Application Form Submission 

Title: Mrs

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): Dewis I was looking after Lady for 12 years 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Understand support and trust 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): Support them 

What is it about PA work which appeals to you? (required): I’m very enjoying doing my job to know I can help people 

What are your hobbies/interests?:Listen music I like to walk around the beach 

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

Do you speak any other languages? (required): Polish and English 

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): Only day Monday Tuesday Thursday Friday 

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.: 

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

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?: 

How many hours of work can you offer per week? (required): 25 

Please indicate the approximate times that you are available for work throughout the week.:Monday AM/Tuesday AM/Thursday AM/Friday AM/