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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): Currently working for 2 elderly clients. Previously done palliative care Sara Steady trained & competent in usage on Hoists. Very familiar with Dementia care & dealing with MS. 

 
What qualities do you think are important when working as a personal assistant with a disabled person? (required): Compassion Empathy Loyalty Trustworthiness Patience Being flexible & adaptable 

 
How do you think you can contribute towards the needs and the independence of a disabled person? (required): Encourage them to lead as much of a normal day to day life as possible & help them achieve their goals. 

 
What is it about PA work which appeals to you? (required): I’m passionate about helping others & the flexibility of the work. 

 
What are your hobbies/interests?: I love to dance, cook & go for long walks. 

 
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): Any early mornings some afternoons ..tea calls , some bed calls and over nights !! 

 
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/ 

 
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?: Pentwyn, llanderyn .. lakeside . Cyncoed ..rumney .. llanrumney 

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

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