Candidate information If confirming multiple appointments, please leave this section blank and complete the multiple booking confirmation table on page 4. Date of birth: Candidate name: (if under 18 years of age, see below*) Proposed occupation Field of employment Other: Duties: * Candidates under the age of 18 years will require parental consent to undergo the assessment, including drug and alcohol testing. Appointment details If confirming multiple appointments, please leave this section blank and complete the multiple booking confirmation table on page 4. Date Time Medical assessment details Type of medical Type of certificate Rail medicals Rail Corp: Yes No (Category 1 or Category 2 medicals require pathology tests to be completed prior to the appointment date) Other medical assessments (if more than one type of Other: Other: medical is required, please also select from the additional drop down box) Do you require company-specific paperwork to be completed? Yes No If yes, please email your company template through to us prior to appointment.
Candidate information If confirming multiple appointments, please leave this section blank and complete the multiple booking confirmation table on page 4. Candidate name: Date of birth: (if under 18 years of age, see below*) Proposed occupation Field of employment Other: Duties: * Candidates under the age of 18 years will require parental consent to undergo the assessment, including drug and alcohol testing. Appointment details If confirming multiple appointments, please leave this section blank and complete the multiple booking confirmation table on page 4. Date Time Medical assessment details Type of medical Type of certificate Rail medicals (Category 1 or Category 2 medicals require pathology tests to be completed prior to the appointment date) Rail Corp: Yes No Other medical assessments (if more than one type of medical is required, please also select from the additional drop down box) Other: Other: Do you require company-specific paperwork to be completed? Yes No If yes, please email your company template through to us prior to appointment.
adm.f.1.1.2-Occupational-Health-Assessment-booking-confirmation-form.docx