Form 23 - Application For Enrollment To Practice Before The Internal Revenue Service 2006 Page 3

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SCHEDULE A

(For use by former Internal Revenue Service employees only)

Instructions:

Complete Schedule A only if your enrollment application is based on former Internal Revenue Service employment. Include only qualifying employment.

Section 10.4(b)(3) of Treasury Department Circular No. 230, provides that enrollment resulting from employment in the Internal Revenue Service may be

of unlimited scope or may be limited to permit the presentation of matters only of the particular class or only before the particular unit or division of the

Internal Revenue Service for which the former employment in the Internal Revenue Service has qualified the applicant. It shall be requisite for enrollment

resulting from such employment that the applicant shall have had a minimum of 5 years continuous employment in the Internal Revenue Service and during

such time was regularly engaged in applying and interpreting the provisions of the Internal Revenue Code and the regulations thereunder. Application for

enrollment resulting from employment in the Internal Revenue Service must be made within 3 years from the date of separation from such employment. Attach

a copy of your position description for the employment under which you are basing eligibility for enrollment. Also, please attach any information regarding

formal education, training, licenses and work experience that would impact on the approval of your application for enrollment to practice before the IRS.

FORMER INTERNAL REVENUE SERVICE EMPLOYMENT INFORMATION

1. Enter your date of separation from employment with the Internal Revenue Service

(MM/DD/YYYY)

Application for enrollment resulting from employment in the Internal Revenue Service must be made within 3 years from the date of separation from such

employment. The application for enrollment should not be filed until the individual has separated from employment with the Internal Revenue Service.

State the reason

you left Internal Revenue Service employment:

(s)

2. While employed with the Internal Revenue Service, were you ever:

(NOTE: An affirmative answer may not preclude you from being enrolled. However, an untruthful answer may be viewed as the submission of false information,

YES

and may serve as a separate basis for any denial of your application. If particular items have been removed from your personnel file due to the passage of time,

you must answer yes to any of the following relevant questions, as if the items were not removed.)

a. Given a written reprimand?

b. Placed under a Performance Improvement Plan, or given any other written notification of unsatisfactory job performance?

c. Suspended from your job?

d. Notified, in writing, of a proposal to remove you from Internal Revenue Service employment?

e. Under investigation by any branch of the United States government and resigned prior to the investigation's conclusion?

Provide a detailed explanation in Schedule B of any ''YES'' answers to the above questions. Former Internal Revenue Service employees MUST

fully complete question 3. If you need additional space, use Schedule B.

3. Job History

1. Operating Division & Post Of Duty

1. Position Title

Employment Dates