© UAE Certification Guidelines 2017

8

PATHWAY 3 – CERTIFIED PRACTISING CASE MANAGER™ APPLICATION

Title First Name Last Name Gender

Business Address - Street Name/PO Box

Business Address Line 2

Business Address Line 3

Area

Emirate State / Province

Postal code

Country Business Phone Mobile Primary Email Address Secondary Email Address Date of Birth Employer Name (Agency) Position Title Department Name I am applying via the following Vocational Pathway to Certification. Please select and attach evidence of your minimum level of qualification. Copy must be certified. I have attained the minimum vocational case management experience. Please note you must have practised for 12 months (1824 hrs) in the last 3 years? Please attach the Employment Verification Form (copy must be signed by your employer & Certified) OR if Self Employed please attach a Statutory Declaration. Please attach a copy of your Curriculum Vitae (CV) Please attach a scanned copy of all PTD Form A as a record of your PTD activities (each copy must be signed and Certified). Note: You must scan all copies of Form A into one (1) PDF document only. Multiple uploads are not available. I have read the Certification Application Guidelines.

3. Pathway 3

1. Yes 2. No - Please ensure you have read these guidelines prior to continuing with your application 3. Pathway 3 - Diploma OR Certificate OR no formal qualification

3. Pathway 3. 5 years FTE (9120 hrs)

1. Employment Verification Form 2. Self Employed (Statutory Declaration)

Upload PTD Form/s A (One PDF file only of all scanned copies of Form A)

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

C E R T I F I E D C A S E M A N A G E R S U N I T E D A R A B E M I R A T E S

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 & A F F I L I A T E S 1 9 9 6

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. 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.