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Personal Assistant Application Form Submission 

 
Title (required): Miss

Address 2: Rhydyfelin 

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): Nursery nurse, domiciliary care, Nanny and personal care assistant 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Empathy, communication, initiative, trustworthy 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Supportive and patience 

 
What is it about PA work which appeals to you? (required): Building relationships and bonding with service users, choosing my hours and days 

 
What are your hobbies/interests?: Days out with my family, listening to music 

 
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): Days mon-fri between 9-2:30 

 
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?: Cf15 cf14 

 
How many hours of work can you offer per week?: 16 

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