ACT Government Medical Booking Form "*" indicates required fields Applicant DetailsName* First Last Phone number*Date of birth* DD slash MM slash YYYY Email* Preferred Clinic Location*Please select from the drop-down menuQueanbeyanDeakinDirectorate*Please ensure to select the directorate from the drop-down listCanberra Health ServicesCommunity ServicesCorrective ServicesEducation and TrainingJustice and Community SafetyParks and ConservationTransport Canberra and City ServicesEnvironment and PlanningBimberiOther (please detail)Position title* Recruiter Email* AGS Number (if known) Appointment DetailsAvailable dates from:* MM slash DD slash YYYY Available dates to:* MM slash DD slash YYYY Preferred appointment times* Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Medical Components Required* Standard Pre-employment Medical Please specify any special requirements Upload filesPlease upload any previous medical records, medical management plans, or any other relevant documentation.Max. file size: 200 MB.Comments
