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Personal Assistant Application Form Submission 

 
Title (required): Miss. 

Town (required): Cardiff 
County (required): Wales 

 
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 have level 1 health and social care I’ve also completed loads of online courses with the open university such as mental health courses . I’ve grown up looking after my great nan (doing her shopping for her, making cups of tea , helping her get dressed and preparing meals) Since a young age I’ve wanted to work within the care sector and make a difference. I’m a kind caring individual who’s always looking for a challenge 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Someone who’s patient friendly kind and caring 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): I can help out with day to day tasks we’ll still assure the service user gets there own independence such as choosing what they want to do through out the day or what they want to eat or wear 

 
What is it about PA work which appeals to you? (required): What appeals to me is that I will be making a difference in someone’s everyday life 

 
What are your hobbies/interests?: I enjoy watching movies such as Harry Potter, I enjoy baking , shopping and speanding time with my family 

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

 
Do you drive? (required): No 
Are you a vehicle owner?  (required): No 
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): Monday to Friday 

 
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 

 
How many hours of work can you offer per week?: 40 

 
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/Thursday Overnight/Friday AM/