Participant Details

Participant First Name *

Participant Last Name *

Date of Birth

Participant Mobile Number *

Participant Email *

Proposed Role *

Is the participant required to pay for this assessment? *

YesNo

Is this an International Booking? *

YesNo

Preferred Location (Provide suburb & postcode)

Country

Alternate Location (Provide suburb & postcode)

Country

Available Day - First Preference

Time available from:

Time available to:

Available Day - Second Preference

Time available from -Second Preference:

Time available to - Second Preference

Available Day - Third Preference

Time available from - Third Preference:

Time available to - Third Preference

Medical Required

QPS Recruit ApplicantsProtective Service Officer ApplicantsWatchhouse Officer Applicants

Notes:

Please note:

If you wish to book a medical that differs from the above services, please contact a MAX Health Program Coordinator first on 1300 307 418 or via email ppm@injurynet.com.au
Cancellations, reschedules and non-attendances will incur a fee

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