93 / 104
37
C
E
R
T
I
F
I
E
D
C
A
S
E
M
A
N
A
G
E
R
S
U
N
I
T
E
D
A
R
A
B
E
M
I
R
A
T
E
S
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.
C
A
S
E
M
A
N
A
G
E
M
E
N
T
S
O
C
I
E
T
Y
O
F
A
U
S
T
R
A
L
I
A
&
N
E
W
Z
E
A
L
A
N
D
&
A
F
F
I
L
I
A
T
E
S
1
9
9
6
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 4 - Referee Form 1 – Page 2 of 2
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.
Please provide a comprehensive
description,
including
your
comments and observations, in
relation to the vocational
experience and performance of
the applicant as it relates to their
case management role (i.e.
practical,
managerial
or
theoretical)
(150 – 200 words)
Do you know of any information
that may give rise to concern of
the applicant that may disqualify
the applicant as being a fit and
proper person for recognition by
the CMSA as a Certified Case
Manager™?
Yes
Please provide details:
No
Comments (optional):
Please
add
any
additional
information or comments that you
consider relevant for the attention
of the CMSA.
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 applicant receiving certification nor
unduly challenge the veracity, integrity or fidelity of the Society, it’s
members and the profession of Case Management.
Signature:
_________________________________________
Date:
EXAMPLE ONLY