ACT Government Medical Booking Form for Youth Justice and Adolescent Services Division

"*" indicates required fields

Applicant Details

Name*
DD slash MM slash YYYY
Please select from the drop-down menu
Medical Components Required:*
Please upload your Job Description (JD) in either pdf or word document (NOT the Letter of Offer with salary). If you do not have a JD, please ensure to request one from your recruiter. Without JD, your booking will not be proceeded.
Max. file size: 2 MB.

Appointment Details

DD slash MM slash YYYY
1st Suitable Time*
:
DD slash MM slash YYYY
2nd Suitable Time*
:
DD slash MM slash YYYY
3rd Suitable Time*
:
This field is hidden when viewing the form
MM slash DD slash YYYY
This field is hidden when viewing the form
MM slash DD slash YYYY
This field is hidden when viewing the form
Preferred appointment times*
Please upload any previous medical records, medical management plans, or any other relevant documentation.
Max. file size: 2 MB.