CDM, CFPP Credentialing Exam Candidate Handbook - Cover3

PATHWAY III & V CDM®
CREDENTIALING EXAM APPLICATION
AUGUST 2023
CBDM EMPLOYMENT VERIFICATION FORM - Required for Pathways III & V only
REQUIREMENTS: Work experience must be equal to a minimum of two years full-time non-commercial foodservice management
work experience for Pathway III and IV or five years full-time non-commercial foodservice management work experience for Pathway V.
* Work experience must be in a non-commercial facility/institution in a management role and include third-party oversight
* Completed form and corresponding description must be submitted during the online exam application process. Job title listed below
must match title on job description provided by the employer.
First Name
Phone Number (
Address
City
)
Last Name
E-mail Address
State
Zip
EMPLOYMENT INFORMATION: Employment will be verified for the dates listed below. If at the time of exam registration the work
experience or any other eligibility requirements have changed, the exam candidate must meet current eligibility requirements and
complete the current Employment Verification Form and exam application.
EMPLOYMENT:
Job Title
Place of Employment
Address
City
Name of Immediate Supervisor
Work Phone (
State
Title
EMPLOYMENT VERIFICATION MUST BE COMPLETED BY IMMEDIATE SUPERVISOR OR HUMAN RESOURCES MANAGER
Candidate employed for above listed position under supervision by above listed person from
(mo/day/yr)
Do you attest to the accuracy of the employer-provided job description provided by the candidate listed above?
[ ] Yes
[
[ ] Yes
[
] No
Do you attest that the foodservice management work experience is equivalent to two years of full-time work for Pathway III or
five years full-time for Pathway V?
] No
What survey and/or inspection process is completed in the department of employment at the facility listed above? (i.e.:
State Health Department, TJC, CMS, etc.)
Has candidate performed satisfactorily while employed in the above listed position/job title?
[ ] Yes
[
] No
Are you aware of any information which would adversely reflect on the character or competence of this person? If yes,
please send your concerns to exam@CBDMonline.org.
[ ] Yes
[ ] No
I hereby certify that the above information is correct to the best of my knowledge. If I did not supervise the individual for the full dates
of employment, I attest that I have verified the accuracy of the job description and employment information provided.
Name of Supervisor or Human Resources Manager (Please Print)
Signature of Supervisor or Human Resources Manager
Date
E-mail Address:
Applicant, Please Note: If the required length of relevant work experience is not met by your current employer, please submit
other previous work experience by completing/submitting a separate form and corresponding job description for employer.
The Certifying Board for Dietary Managers reserves the right to verify information supplied on this page.
®
The exam candidate should not complete this section. It must be completed by the supervisor. All questions must be answered.
to
(mo/day/yr)
Dates: from
(mo/day/yr)
)
Zip
to
(mo/day/yr)
MI
Work Phone (
)
CDM, CFPP Credentialing Exam Candidate Handbook

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