Oab Form E004 - Experience Verification Form (Page 2 of 2) in pdf

Oab Form E004 - Experience Verification Form Page 2

SECTION II- VERIFIER’S INFORMATION

7. [ ] CPA or [ ] NON-CPA

8. Certificate/License #: ___________

State of Licensure: ___________

9. Verifier’s name and title : ___________________________________________________

10. Relationship to Applicant: ___________________________________________________

11. Verifier’s business name: ___________________________________________________

12. Verifier’s business address: _________________________________________________

13. Phone: ___________________________

Email: ____________________________

SECTION III – ATTESTATION

I understand that the Board will verify this information to the extent it deems necessary to

establish that I have satisfied the eligibility requirements set forth in Section 15.9E of the

Oklahoma Accountancy Act.

Signature of applicant: ___________________________ Date: ________________________

Daytime Telephone Number: ______________________ Email: _______________________

Additional Information about the Experience Verification Process

 You may submit this form via fax (405)521-3118 or via email to mschosser@oab.ok.gov

 Applicants must complete a separate form for each period of employment

 The Board will send correspondence to the listed verifier via email. Please allow 1-2 weeks

for processing and response time.

 Once approved, you will receive an approval notification via email explaining the next steps

in the certification process and info regarding the Application for Certification.

 Please hold on to your AICPA Ethics Comprehensive Course certificate. This document will

need to be submitted with the Application for Certification.

 If you have any questions please feel free to contact the Melissa Schosser

at (405) 522-3092.

Oab Form E004 - Experience Verification Form Page 2