Request for PESCI

PESCI PESCI request form

Please note: All forms fields are mandatory except where otherwise stated.

Request for Pre-Employment Structured Clinical Interview

Standard Pathway only

Contact name Contact email

Please provide your contact email address to ensure you receive a delivery confirmation of this form.

Hospital and Health Service Facility Phone

Standard pathway candidate?

Is the candidate currently employed with Queensland health?

Candidate's facility

Is the candidate commencing or currently on the ICU Vocational Training Pathway?

Registration type being sought

CANDIDATE DETAILS

Please provide candidate contact details not agency details.

Candidate name Candidate email Candidate phone Candidate postal address

Is candidate via RMO campaign?

Please confirm candidate has:

English language proficiency

AMC MCQ (PART 1)

Please note: For IELTS, candidate must have a minimum of 7 in each category. For OET, candidate must have a minimum of B in each category.

Is the candidate via an agency?

POSITION DETAILS

Primary location of position Secondary location of position (optional) Position Position specialty Position Department Director

The Department Director must complete and submit the supplementary information form (role description for an IMG undertaking a PESCI for a PHO position within Queensland Health). Please note: If a supplementary form has been completed in the last 2 months and no changes have occurred in the supervision of this role, a new supplementary form is not required.

Position contact phone Expected date of commencement

Provide a brief description of the orientation that will be provided to the candidate

VIDEO CONFERENCING

Is video conferencing required?

ATTACHMENTS

File types accepted include pdf, doc, docx. Maximum file size is 8MB.

Curriculum vitae

Must be in Queensland Health format - please refer to QLD Health CV template (DOC).

Position description

FURTHER REQUIREMENTS

Due to file size limitations of this online form, to progress your PESCI request the PESCI team requires the following documentation to be emailed to us via CSDS-PESCI@health.qld.gov.au within two working days of receipt of this online form.

Recruitment and Selection Paperwork
Letter of Offer
Supplementary Role Description
Certified copy of candidate documents (passport, academic record, AMC MCQ, IELTS)

Please ensure all form fields are complete and free from errors before submitting.

Request for PESCI

Please check and correct the following below to continue: