© 2013 Fellow Application Guidelines

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Fellow Online Application Form

Title

First Name

Last Name

Agency

Position Title

Department Name

Business Address Line 1

Business Address Line 2

Business Address Line 3

Suburb

State

Postcode

Postal Address Line 1

Postal Address Line 2

Postal Address Line 3

Suburb

State

Postcode

Business Phone

Mobile

Primary Email Address

Secondary Email Address

Date of Birth

Qualifications (please list) I have attained the minimum 10 years FTE (18240 hrs) vocational case management experience. Please note you must have practised for 12 months (1824 hrs) in the last 3 years Please attach the Employment Verification Form signed by your employer & Certified OR if Self Employed please attach a Statutory Declaration.

1. Employment Verification Form 2. Self Employed (Statutory Declaration)

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 1 9 9 6

Fellow Members (FCMSA) of the Case Management Society of Australia & New Zealand (CMSA) adhere to the CMSA National Standards & National Code of Ethics for Case Management in all their day-to-day professional interactions with colleagues, the community, clients & /or representatives, key stakeholders & employer thus contributing to the veracity, integrity & fidelity of the profession of case management.