Form 12339-C - Advisory Committee On Tax Exempt And Government Entities Membership Application

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Department of the Treasury - Internal Revenue Service
12339-C
OMB Number
Form
Advisory Committee on Tax Exempt and
1545-1791
(August 2017)
Government Entities - Membership Application
Complete all five parts of this application and return it no later than close of business of the date specified in the Federal Register
Notice. See
irs.gov
for additional information.
NOTE: Incomplete applications will not be processed.
You may e-mail your application to
tege.advisory.comm@irs.gov
or
FAX your application to (888) 269-7419.
PART I – Applicant Information
(Some of the information requested in Part I is required to perform an FBI background check)
First name
Middle name
Last name
Home street address
Home telephone number
City
State
ZIP code
Business name
Job title
Business address
City
State
ZIP code
Business telephone number
Business FAX number
Business email address
Which vacancy listed on the Federal Register Notice are you applying for
Employee Plans
Exempt Organizations
Indian Tribal Governments
Tax Exempt Bonds
Other
(specify)
PART II - Desired Skills and Qualifications
Attach a two page maximum statement, including recent examples, addressing your specific skills and qualifications as they relate to:
● Experience with TE/GE programs: examinations, determinations, voluntary compliance, communications, etc.
● Experience in business management and improvement.
● Experience in administration or data mining.
● Experience establishing successful strategic partnerships.
● Ability to examine issues from a "macro" viewpoint, and to effectively communicate your views and recommendations about these
issues.
PART III - Applicant Resume
Attach a copy of your resume, including prior Treasury or IRS employment. State positions, titles, and dates of employment. In addition,
list any professional credentials, membership in professional organizations and local liaison activities with IRS.
12339-C
Form
(Rev. 8-2017)
Catalog Number 58763Y

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