©ANZ Certification Application Guidelines eBook

11

Please attach a scanned copy of all PTD Form A as a record of your PTD activities (each copy must be signed and Certified). Note: You must scan all copies of Form A into one (1) PDF document only. Multiple uploads are not available. Please attach a scanned copy of the PTD Form B as a summary of all 72 hrs of PTD activities (copy must be signed and Certified). Please attach Referee Form 1 (copy must be signed and Certified) Please attach Referee Form 2 (copy must be signed and Certified) I solemnly and sincerely commit to read, understand, utilise and apply the CMSA National Standards and National Code of Ethics within all my professional interactions as a Certified Case Manager (Non Practising)™ and member of the CMSA. I solemnly and sincerely declare that the contents of this application, including all information provided for and on my behalf, is true and correct to the best of my knowledge and belief. I acknowledge that the CMSA will conduct random audits of applications and if audited I will be required to provide evidence of any or all claims within my application within 28 days of notice by the CMSA. I have read and acknowledge the Certification Appeals Policy. I have read and consent to the CMSA Privacy Policy (see www.cmsa.org.au) and understand how it relates to the use of my personal information. I have read, acknowledge and agree to abide by the CMSA Constitution and By-laws Disclaimer of Liability - I acknowledge full responsibility for any (if required) Professional Indemnity Insurance and recognise the CMSA is not liable for any professional malpractice, misconduct, injury, damages, fraudulent or criminal acts pursuant to my registration as a Certified Case Manager (Non Practising)™

Upload PTD Form/s A (One PDF file only of all scanned copies of Form A)

Upload PTD Form B

1. Employment Verification Form OR Statutory Declaration 2. Curriculum Vitae (CV) 3. Professional Training and Development (PTD) Form 4. Certificate of Attainment CMCT01

5. Referee 1 6. Referee 2

I hereby agree

I hereby declare and acknowledge

I hereby declare and acknowledge

1. Yes 2. No

I hereby agree

I hereby acknowledge

COPYRIGHT © 2017 Case Management Society of Australia and New Zealand and Affiliates (CMSA)

C E R T I F I E D C A S E M A N A G E R A U S T R A L I A & N E W Z E A L A N D

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

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.