© ANZ National Certification Learn More Booklet

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Attachment 4 - Referee Form 1 – Page 2 of 2

Please provide a comprehensive description, including your comments and observations, in relation to the vocational experience and performance of the applicant as it relates to their case management role (i.e. practical, managerial or theoretical) (150 – 200 words) Do you know of any information that may give rise to concern of the applicant that may disqualify the applicant as being a fit and proper person for recognition by the CMSA as a Certified Case Manager™ ? Comments (optional): Please add any additional information or comments that you consider relevant for the attention

Yes Please provide details: No

of the CMSA. Declaration:

I solemnly and sincerely declare that the information I have provided is true and correct to the best of my knowledge and belief. I solemnly and sincerely declare that I have not omitted any information that may give rise to concerns by the Case Management Society of Australia and New Zealand and Affiliates (CMSA) as to the appropriateness of the applicant receiving certification nor unduly challenge the veracity, integrity or fidel ity of the Society, it’s members and the profession of Case Management.

Signature:

_________________________________________

Date:

COPYRIGHT © 2017 Case Management Society of Australia and New Zealand and Affiliates (CMSA)

C A S E M A N A G E M E N T S O C I E T Y O F A U S T R A L I A & N E W Z E A L A N D 1 9 9 6

C E R T I F I E D C A S E M A N A G E R A U S T R A L I A & N E W Z E A L A N D

The Case Management Society of Australia and New Zealand and Affiliates (CMSA) Certification sets the benchmark of excellence in case management. Certified Practising Case Managers™ (CPCM) and Certified Case Managers (Non Practising)™ (CCMNP) adhere to the CMSA National Standards and National Code of Ethics for Case Management and are recognised for their advanced education, experience, knowledge and skills by their colleagues, consumers and employers.