Dbpr Form Cpa 32 - Certification Of Work Experience
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2STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
BOARD OF ACCOUNTANCY
240 N. W. 76th Drive, Suite A
Gainesville, Florida 32607
CERTIFICATION OF WORK EXPERIENCE
INSTRUCTION TO EMPLOYEE: Please sign this statement, forward to employer for completion and return to the
Board of Accountancy.
I hereby authorize my employers (past and present) to release to the Florida Board of Accountancy any information, files
and/or records as it may deem necessary in the processing of this certification of work experience.
Name of employee _________________________________________________________________________________
(PLEASE PRINT OR TYPE)
Address of employee _______________________________________________________________________________
STREET OR P.O. BOX #
CITY
STATE
ZIP
_________________________________________________________________________________________________________________________
DATE
SIGNATURE OF EMPLOYEE
INSTRUCTIONS TO EMPLOYER: Please complete, have notarized and forward this Certification of Work
Experience form to the Board of Accountancy, 240 N. W. 76th Drive, Suite A, Gainesville, Florida 32607.
1. Name of employer _______________________________________________________________________________
2. Location of office in which employee was employed _____________________________________________________
_______________________________________________________________________________________________
3. FULL-TIME EMPLOYMENT: From ______________________________ To ________________________________
Applicant still employed:
YES
NO
4. PART-TIME EMPLOYMENT (Give complete details below. Attach additional statement if necessary.)
Employed from ____________________________________________ To __________________________________
Number weeks employed _____________________________________
Average number hours per week employed _______________________
Total hours employed ________________________________________
COMPLETE REVERSE SIDE
DBPR FORM CPA 32
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