© UAE Certification Guidelines 2017

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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 Referee Form 1 (copy must be signed and Certified) Please attach Referee Form 2 (copy must be signed and Certified) I have submitted the following evidence as a mandatory requirement of my application and acknowledge that failure to do so will render my application incomplete for the purpose of assessment by the CMSA. I solemnly and sincerely commit to read, understand, utilise and apply the CMSA National Standards and National Code of Ethics within all my professional interactions as a Certified Practising Case Manager™ and member of the CMSA. I solemnly and sincerely declare that the contents of this application, including all information provided for and on my behalf, is true and correct to the best of my knowledge and belief. I acknowledge that the CMSA will conduct random audits of applications and if audited I will be required to provide evidence of any or all claims within my application within 28 days of notice by the CMSA. I have read and acknowledge the Certification Appeals Policy. I have read and consent to the CMSA Privacy Policy (see www.cmsa.org.au) and understand how it relates to the use of my personal information. I have read, acknowledge and agree to abide by the CMSA Constitution and By-laws Disclaimer of Liability - I acknowledge full responsibility for any (if required) Professional Indemnity Insurance and recognise the CMSA is not liable for any professional malpractice, misconduct, injury, damages, fraudulent or criminal acts pursuant to my registration as a Certified Practising Case Manager™ Please attach a copy of your Curriculum Vitae (CV)

1. Pathway 1- 2 years FTE (3648 hrs)

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

1. Qualifications 2. Employment Verification Form OR Statutory Declaration 3. Curriculum Vitae (CV)

4. Referee 1 5. Referee 2

I hereby agree

I hereby declare and acknowledge

I hereby declare and acknowledge

1. Yes 2. No

I hereby agree

I hereby acknowledge

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.

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