PESCI application form
Transcription
PESCI application form
Please email to: [email protected] Or mail to: Australian Medical Review Centre ABN: 49 159 636 049 Level 1, 7-9 Churchill Avenue Strathfield, NSW 2135 Ph: (02) 9007 4235 or 045 045 8086 PESCI WORKSHOP Application Form Date: 22 March 2015 Fee: $350 The PESCI Workshop is designed to aid those who have a job offer or are in the process of looking for work. The course aims to: • • • Explain the PESCI, its contents, process and format • Give candidates a chance to practice and participate in interviews and roleplays. Help candidates prepare for PESCI-style questions Allow candidates to adjust and improve their clinical consultation skills ______________________________________________________________________________ Name:_________________________________________________________________________ Address: ______________________________________________________________ ________ Suburb: _________________ ___State: ________________________Postcode:____________ AMC Candidate number: __________________________________________________________ Phone/Mobile number: ___________________Email Address: ____________________________ Payment method: o Online Transfer: Account Name: Australian Medical Review Centre Pty Ltd. Account Details: BSB – 032 028 Account number – 376 081 Bank Name: Westpac Banking Corporation Branch: Haymarket, Sydney Branch Swift code: WPACAU2s Reference: Your Name o Credit Card You may request for a credit card authorization form. Please note that credit card transactions are subject to 2.4% surcharge.