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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 8 - Re-endorsed Certified Case Manager
™
- Employment Verification Form - Page 2 of 2
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:
“Employer” Job Title:
“Employer”
Business Phone:
“Employer”
Mobile:
“Employer”
Email:
Date of “Employee” appointment:
Is the “Employee” presently
employed
with
your
Organisation or Company?
Yes
No
Please provide end date of employment contract:
Average hours
of “Employee”
per week
?
“Employee”
Total
FTE
equivalent of hours for term of
employment?
FTE are based on 38 hours per
week over 48 weeks.
hours
Do you know of any information
that may give rise to concern of
the “Employee” that may
disqualify the “Employee” as
being a fit and proper person for
recognition by the CMSA as a
Certified C
ase Manager™?
Yes
Please provide details:
No
“Employer”
Comments
(optional):
Please
add
any
additional
information or comments in relation
to the “Employee” that you consider
relevant for the attention of the
CMSA.
“Employer”
Declaration:
I solemnly and sincerely declare that the information I have
provided is true and correct to the best of my knowledge and belief.
I solemnly and sincerely declare that I have not omitted any
information that may give rise to concerns by the Case Management
Society of Australia and New Zealand and Affiliates (CMSA) as to
the appropriateness of the “employee” receiving certification nor
unduly challenge the veracity, integrity or fidelity of the Society, its
members and the profession of Case Management.
“Employer”
Signature:
_________________________________________
Date: