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Personal Assistant Application Form Submission 

Title (required): Mrs. 

Town (required): Pontypridd 

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 a 99 yr old grandmother who I have assisted with taking her shopping, cleaning and collecting prescriptions for. Although I have not worked as a carer I have worked on a helpline offering empathy to Carers and people being cared for too. 

What qualities do you think are important when working as a personal assistant with a disabled person? (required): Understanding, empathetic and punctual and always treating information as confidential. Being able to help make their life easier in process. 

How do you think you can contribute towards the needs and the independence of a disabled person? (required): I think I can help by offering my assistance and listening to their needs, and then acting upon their requests. 

What is it about PA work which appeals to you? (required): I’m cery interested in this work as opposed to working on house to house as it is more personal. 

What are your hobbies/interests?: Reading, walking, listening to music, watching films. 

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 apart from through night 

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?: Cardiff RCT 

How many hours of work can you offer per week?: 30 

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/Sunday PM / 
Further Information: