© UAE Certification Guidelines 2017

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PATHWAY 2 – 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.

2. Pathway 2

I have read the Certification Application Guidelines.

1. Yes 2. No - Please ensure you have read these guidelines prior to continuing with your application

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.

2. Pathway 2 - Undergraduate Bachelor degree (from any discipline)

2. Pathway 2 - 3 years FTE (5472 hrs)

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

Please attach a copy of your Curriculum Vitae (CV)

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.