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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.
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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)
Attachment 9 - Re-endorsed Certified Case Manager™ - Employment Verification Form - Page 1 of 2
RE-ENDORSED CERTIFIED CASE MANAGER™ - 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 re-
endorsement as a Certified Case Manager™, i.e. Certified
Practising Case Manager™ or Certified Case Manager (Non
Practising)™. Pursuant to this application the “Employee”
must submit evidence of their vocational case management
practice experience (i.e. practical, managerial or theoretical).
An applicant must demonstrate they have at least 12 months
(1824 hrs) practice in the last 3 years. for the said re-
endorsement.
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
(Prof, Dr, 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:
Street Name / PO Box:
Area:
Emirate State / Province:
Postal Code:
Country:
EXAMPLE ONLY