OKLAHOMA ACCOUNTANCY BOARD
rd
201 NW 63
Street, Suite 210
Oklahoma City, OK 73116
Randall A. Ross, CPA
Ph: (405) 521-2397 Fax: (405) 521-3118
Executive Director
EXPERIENCE VERIFICATION FORM
DO NOT FILE THIS FORM UNTIL YOU RECEIVE OFFICIAL NOTIFICATION FROM THE BOARD
THAT YOU HAVE SUCCESSFULLY PASSED THE EXAMINATION
Pursuant to Section 10:15-3-2(3) of the Oklahoma Administrative Code, “Documentation has
been provided that the certification applicant has a total of Eighteen hundred (1,800) hours of
part time or full time work experience in accounting as described in Title 59, Section 15.9.E of
the Act. Work experience must have been obtained within the four (4) years immediately prior to
filing the application for certification. This requirement may be satisfied through work experience
in government, industry, academia, or public practice. Acceptable work experience includes
accounting, attest, tax, and related services.”
Applicant’s full name: __________________________________
Date: _________
SECTION I - EMPLOYER INFORMATION
1. Employment type: [ ]Full-time [ ]Part-time [ ]Self-employment [ ] Internship*
*Note: Experience earned through an internship is not eligible if the applicant earned college
credit for the internship and those credits were used to meet the educational requirements to
sit for the CPA/PA exam.
2. Employment classification:
[ ] Public [ ] Government [ ] Industry [ ] Academia
3. Business Name: ___________________________________________________________
4. Business Address:__________________________________ Phone: _________________
5. Start Date: _____________
End Date: ___________
Total hours**:____________
**Note: Regardless of start date, only report hours worked within the last four years.
6. Summarize your accounting related work experience during this time period:
QUESTIONS CONTINUE, SIGN AND DATE ON REVERSE SIDE
1
OAB FORM E004
Rev. 8/2013