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34

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: