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 Personal Assistant Application Form Submission 

Title (required): Miss. 
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): I am a trained and working healthcare support worker and I have been working as a support worker for 3 years 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Patient and communication skills Empathy Positive attitude Reliable 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): Empower, prompt, encourage them in their daily activities and decision making 

What is it about PA work which appeals to you? (required): I am a highly professional and organised person who enjoys helping and caring for others 

What are your hobbies/interests?:Watching movies Cooking Working out 

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

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

Do you drive? (required): No 
Are you a vehicle owner?  (required): Yes 
Do you smoke? (required): Yes 

Are you able to undertake training? (required): Yes 

What days/nights are you able to work, or prefer to work?  (required): nights 

Are there any circumstances which would prevent you from providing cover or swapping a shift? (required): Yes 

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?:Wales 

How many hours of work can you offer per week? (required): 20 

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