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Personal Assistant Application Form Submission 

Title: Mrs 

Town (required): Fairwater 
County (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): Support worker for young people and children. At Procare Company branch Safehand. In Cardiff. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Supportif, good listener, helping and relying person. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): Good communication skill and satisfied his need, respect his suggestions. 

What is it about PA work which appeals to you? (required): Ready to support someone in need physically, morally. 

What are your hobbies/interests?:Cooking, sowing clothes. 

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

Do you speak any other languages? (required): French, Somalie, Arab 

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): Monday to Friday. 

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?:Fairwater, Rhyder, Canton. 

How many hours of work can you offer per week? (required): 16, 20 hours per week 

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