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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.
COPYRIGHT © 2017 Case Management Society of Australia and New Zealand and Affiliates (CMSA)
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Attachment 5 - Referee Form 2 – Page 1 of 2
CERTIFIED CASE MANAGER™
- REFEREE TWO (2) FORM
TO THE REFEREE
Your role as a
“
referee
”
is important in the substantiation
of information provided by the
“
applic
ant”
to the CMSA.
Applicants seeking national recognition as a Certified Case
Manager™,
i.e.
Certified Practising Case Manager™ or
Certified Case Manager (Non Practising)™
, must provide
full details of their referees. It is recommended by the
CMSA that as a nominated referee you take the time to
review and discuss the application and supporting
documentation prior to it being submitted online to the
CMSA. It is important to know that as a referee, you may
be contacted by a representative of the CMSA to either
clarify or verify any details or claims made by the
applicant or yourself in support of the aforesaid
application for a Certified Case Manager
™.
Please complete, print and sign this form prior to
returning it to the applicant. Information must be typed
into this form. Handwritten versions of the referee form
will not be accepted by the CMSA.
Applicant Name:
I am providing a professional reference for (insert full name):
Referee 2 details
Title
(Dr, Prof, Mr, Mrs, Ms):
SURNAME:
GIVEN/FIRST name:
Position title:
Organisation or Company name:
Postal address:
State/
Territory
Postcode
Country
if other than Australia
Phone:
Mobile:
Email:
In what professional capacity do
you know the applicant?
(e.g. academic, advisor, case
manager, colleague, consultant,
clinician, educator, executive,
manager, mentor, peer, policy
planner, practitioner, supervisor,
researcher etc)
How long have you known the
applicant?
Please record approximate time in
years and actual time in months if
this period is less than 2 years.