Jobs Statewide Participant Form | Adelaide Driving Institute

Please complete the following details to arrange driving lessons through Jobs Statewide and Adelaide Driving Institute.

Section 1: Participant Details

Full Name *(Required)

Mobile Number *(Required)

Email Address *(Required)

Preferred Contact Method

Phone callSMSEmail

Address / Preferred Lesson Location

Section 2: Driving Experience

Current Licence/Permit Status

Learner’s permitOverseas licenceOther

Driving Experience

BeginnerSome previous driving experienceExperienced learner requiring test preparation

Hours completed

Section 3: Jobs Statewide Details

Purchase Order (PO) Number provided by Jobs Statewide *(Required)

Please enter the PO number supplied to you by your Jobs Statewide employment consultant. If you have not received a PO number, contact your consultant before submitting this form.

Jobs Statewide Branch

Employment Consultant Name

Employment Consultant Contact (phone / email)

Approved Package *

Single Lesson – $1004 Driving Lessons – $3502 Lessons + 1 Test Attempt – $5003 Driving Lessons + 2 VORT Test Attempts – $800Other package approved by Jobs Statewide

Approved Amount *(Required)

Enter the approved amount exactly as agreed with Jobs Statewide. ADI will verify this against the PO before confirming.

The package and amount entered here are subject to verification by ADI against the Jobs Statewide purchase order before lessons are confirmed.

Section 4: Booking Preferences

Availability — tick every day and time that suits you

Day	7am	8am	9am	10am	11am	12pm	1pm	2pm	3pm	4pm	5pm	6pm	7pm	8pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Please select all days and times that suit you. These are preferences only and do not confirm a booking.

Additional Booking Information

Section 5: Acknowledgement

I confirm that the information provided is accurate and may be used by Adelaide Driving Institute to arrange driving lessons, manage bookings and coordinate the approved services with Jobs Statewide.I understand that lesson and test bookings are subject to availability and applicable booking requirements.

Participant Name *(Required)

Date *(Required)

Booking Disclaimer: Submitting this form does not confirm a booking. Adelaide Driving Institute will verify the purchase order and package approval with Jobs Statewide before confirming lessons. All bookings are subject to instructor availability.

I confirm that the information provided is accurate, and I understand that ADI must verify the purchase order and package approval before confirming lessons.