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Personal Assistant Application Form Submission 

Title (required): Mrs. 

Town (required): CARDIFF 
County (required): UK 

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 still working as a bank staff in Penylan Nursing Home. For around one year. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Friendly Helpful Humour Empathy 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): My duty is to support him and make his life easier and happier. 

What is it about PA work which appeals to you? (required): I gain a friendship of someone in need. 

What are your hobbies/interests?: Reading Slow 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): No 
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 

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?: Splott Adamsdown Penylan Albany Road Newport Road 

How many hours of work can you offer per week?: 24 

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/Friday PM/Friday Overnight/Saturday AM/Saturday PM/Saturday Overnight/Sunday AM/Sunday PM /Sunday Overnight/ 

Further Information: I can do nights shifts but not more than 24 hours