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Personal Assistant Application Form Submission

Title (required): Mrs.

Address 2: Whitchurch
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): Looked after a lady with vascular dementia for 4 years, employed by Dewis.

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Care and understanding, & having a sense of humour.

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I have been doing caring work, & I also do house work.

What is it about PA work which appeals to you? (required): Helping someone to enjoy their life to the full

What are your hobbies/interests?: Gardening, knitting, decorating, & reading

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): Any

Are there any circumstances which would prevent you from providing cover or swapping a shift? (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/

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 north

How many hours of work can you offer per week?: 12


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