PPMForm - Bosch

Bosch Pre-Employment Medical Request Form

To enable Injurynet to coordinate a suitable appointment, you are required to complete all the sections below. Should you not be able to complete some of these sections you may need to contact Bosch to obtain the information.

Once you have submitted this form you will receive an email confirming the information you have provided and instructions for attending your appointment. If you do not receive this email, or the information you have provided is incorrect, please contact Injurynet during business hours on 1300 307 418.

Candidate Details

First Name:

Family Name:

Date Of Birth:

Gender:

Mobile Phone No:

Alternate Phone No:

At least one phone number is required

Email Address:

Position Applied For:

Task Analysis:

Worksite:

HR Contact:

Other Contact Name:

Contact name is required

Service Details

Medical Required:

Candidate Availability

Bosch request your appointment to be completed as soon as possible, please provide your earliest availability by selecting at least 9 hours over a minimum of 2 weekdays. If you would like to add additional days to your selection please click on +

Injurynet will book your medical based on the date and times you have provided, please be aware if you cancel, reschedule or do not attend your appointment Bosch will incur a fee.

Day 1:

Day 2:

Day 3:

Day 4:

Day 5:

Day 6:

Day 7:

Day 8:

Day 9:

Preferred Suburb:

Alternative Location:

Injurynet will endeavour to book an appointment at your preferred location, please note you may be required to travel up to 30 minutes to attend a clinic

Additional Notes:

Bosch Pre-Employment Medical Request Form

Candidate Details

Service Details

Candidate Availability

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