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Personal Assistant Application Form Submission 

Title (required): Mr. 

Town (required): Cardiff 
County (required): 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): Masters 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Trustworthy, patients, understanding and good communication 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): Focus on the person not their disability Be positive and celebrate small improvements 

What is it about PA work which appeals to you? (required): Be able to assist and takes responsibility of most of my boss daily activities when instructed to do so 

What are your hobbies/interests?:Music and photography 

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): Tuesday morning or night Thursday morning or night then weekend 

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.:Maybe my lectures 

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

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? (required): 8 hours or more 

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