Application as an Accredited Mediator under AMDRAS – Initial Accreditation
This application is for initial accreditation as a Registered Practitioner who has met the general provisions in accordance with the Australian Mediator and Dispute Resolution Accreditation Standards (AMDRAS). Please refer to www.amdras.au. Conflict Resolution Service is an authorised Accreditation Provider as recognised by AMDRAS to grant accreditation under the Training and Assessment Framework (TAF). CRS work within the AMDRAS and associated guidelines to assist the AMDRAS Board in establishing, regulating and promoting the professional standards of Registered Practitioners.
Applicant Details
Full name
*
First Name
Middle Name
Last Name
Address (street)
*
City
*
State
*
Please Select
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Postcode
*
Mobile
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
CRS Requirements
I have read and understood my obligations under the AMDRAS and agree to comply with these obligations
*
Yes
No
I will take responsibility for maintaining my own records and evidence for seeking re-accreditation in 2 years, and that CRS is not obliged to keep records of any mediations or professional development I undertake to meet re-accreditation requirements
*
Yes
No
I hold a current National Police Check (not older than 3 years)
*
Yes
No
Upload National Police Check
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Will you be working with Children and Young People under 18 years of age?
*
Yes
No
Upload Working With Vulnerable People Check or relevant certification for your state or territory
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Safeguarding Commitment
Do you see any issues with aligning with this commitment?
*
Yes
No
Do you have any current or pending proceedings against you?
*
Yes
No
Training and Assessment
Have you previously completed a recognised Certificate of Training (CoT) or equivalent? (See AMDRAS Clause 25(a)(b)) or Alternative Pathways (AMDRAS Division 8, Clause 35)
*
Yes
No
CoT Course Name
CoT Course Dates
CoT Course Provider
CoT Course Location
Upload a copy of your CoT certificate
Upload a File
Drag and drop files here
Choose a file
Cancel
of
CoT – please provide information to support the alternative pathway application sought
Have you received a Certificate of Assessment (CoA) based on a written assessment (See AMDRAS Clause 27.2(a)), and performance of the role of a mediator in a simulated mediation of at least 2 to 2.5 hours, or equivalent? (See AMDRAS Clause 27.2(b)) or Alternative Pathways (AMDRAS Division 8, Clause 35)
*
Yes
No
CoA Assessment Organisation
Date of simulated mediation
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of assessment
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of notification to applicant of competent assessment
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
See AMDRAS Clause 27(c) and (d)
Upload a copy of your CoA
Upload a File
Drag and drop files here
Choose a file
Cancel
of
CoA – please provide information to support the alternative pathway application sought
Insurance
Are you covered by relevant professional indemnity insurance or have statutory immunity? (See AMDRAS Clause 43)
*
Yes
No
Upload Certificate of Currency or other evidence of insurance cover
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Insurance renewal date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Insurance – please provide more information
Complaints Management
In accordance with AMDRAS Professional Ethics and Responsibilities Domain 'Providing a feedback and complaints mechanism with the ability to escalate complaints to an independent complaint-handling service'. A Recognised Practitioner (RP) and/or the organisation for which you work must provide participants details of the complaints-management system in place.
Is a copy of your Complaints policy attached?
*
Yes
No
Upload Complaints policy
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Complaints policy – please provide more information
Compliance Undertaking
Do you undertake to comply with the AMDRAS Training and Accreditation Framework (TAF) for persons seeking accreditation and once accredited under the AMDRAS?
*
Yes
No
Do you undertake to comply with the AMDRAS Professional Practice Domains which apply to AMDRAS accredited mediators?
*
Yes
No
Do you undertake to comply with any relevant legislation, professional standards and any other requirements that may be relevant to an AMDRAS accredited mediator?
*
Yes
No
Good Character
Are you of good character and do you possess appropriate personal qualities and experience to conduct a mediation process independently, competently and professionally? (See AMDRAS Clause 38(a)(i))
*
Yes
No
Have you provided two character references attesting to your good character? (See AMDRAS Clause 38(b)(i))
*
Yes
No
Upload two character references (refer Appendix C for template)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Disclosure
Have you at any time been disqualified from any type of professional practice?
*
Yes
No
Disclosure (a) – Disqualification: detailed statement and explanation
Have you any unspent criminal convictions?
*
Yes
No
Disclosure (b) – Unspent criminal convictions: detailed statement and explanation
Do you have any impairment(s) that could influence your capacity to discharge your obligations in a competent, honest and professional manner?
*
Yes
No
Disclosure (c) – Impairment: detailed statement and explanation
Have you ever been the subject of a complaint in your role as a mediator where the complaint was upheld and conditions imposed?
*
Yes
No
Disclosure (d) – Upheld complaint: detailed statement and explanation
Have you ever been refused NMAS or AMDRAS accreditation or accreditation renewal?
*
Yes
No
Disclosure (e) – Refused accreditation: detailed statement and explanation
Have you ever had your mediation accreditation suspended or cancelled?
*
Yes
No
Disclosure (f) – Suspended or cancelled accreditation: detailed statement and explanation
Are you currently registered through another RAP?
*
Yes
No
Disclosure (g) – Other RAP registration: detailed statement and explanation (if seeking a transfer, please also complete a transfer form)
Acknowledgement, Undertaking and Consent
Do you acknowledge and agree to be bound by the AMDRAS Code of Ethics and Professional Practice Domains, where they do not conflict with other professional obligations?
*
Yes
No
Do you understand the Ethical Code of Practice and Complaints and Disciplinary Procedure?
*
Yes
No
Do you consent to (See AMDRAS Clause 42):
Your personal information being disclosed to the AMDRAS Board or relevant AMDRAS-related entity
*
Yes
No
Consent 1 – Disclosure to AMDRAS Board: detailed explanation
Your name, registration status and accreditation body released on the AMDRAS National Register
*
Yes
No
Consent 2 – AMDRAS National Register: detailed explanation
The AMDRAS Board or entity releasing the information to other AMDRAS-related entities (but to no-one else without the consent of all parties concerned)
*
Yes
No
Consent 3 – Release to AMDRAS-related entities: detailed explanation
Declaration
I certify that the contents of this Application are true and correct
*
I certify that the contents of this Application are true and correct
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit application
Submit application
Should be Empty: