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Fellow Members (FCMSA) of the Case Management Society of Australia & New Zealand (CMSA) adhere to the
CMSA National Standards & National Code of Ethics for Case Management in all their day-to-day professional
interactions with colleagues, the community, clients & /or representatives, key stakeholders & employer thus
contributing to the veracity, integrity & fidelity of the profession of case management.
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Attachment 1 - Employment Verification Form, Page 1 of 2
FELLOW - EMPLOYMENT VERIFICATION FORM
TO THE EMPLOYER
The information being sought in this form is for the
purpose of verifying the employment details of the named
“Employee”
(past or present) by your Organisation or
Company.
The “Employee”
is seeking national recognition
as a Fellow of the Case Management Society of Australia
and New Zealand (CMSA). Pursuant to this application the
“Employee” must submit evidence of their FTE vocational
practice experience to the CMSA in accordance with the
minimum pre-requisite requirements for the said application.
It is important to know in completing this form for the
“Employee”, and on behalf of your Organisation or
Company, you may be contacted by a representative of
the CMSA to either clarify or verify any details as provided
within this form.
Please complete, print and sign this form prior to
returning it to the
“Employee”
. Information must be typed
into this form. Handwritten versions of the form will not be
accepted by the CMSA.
“
Employee
”
details
I am providing employment information with the full knowledge
and consent and as requested, for and on behalf of
Title
(Dr, Prof, Mr, Mrs, Ms):
SURNAME:
GIVEN/FIRST name:
“Employee”
address:
“Employee”
position title within
your Organisation or Company:
If more than one please list.
Practice area of
“
Employee
”
(as
it relates to case management):
(e.g. academic, advisor, case
manager, consultant, clinician,
educator, executive, manager,
mentor, policy planner, practitioner,
supervisor, researcher etc)
“Employer”
Organisation or
Company Name:
Postal address:
Suburb:
State/Territory (Australia):
Town/City (New Zealand):
Postcode:
Country:
Name of person completing form
on behalf of the “Employer”
Organisation or Company as
named above:
Title
(Dr, Prof, Mr, Mrs, Ms):
SURNAME:
GIVEN/FIRST name: