Cpa Initial License Application For Cpa Certificate And Permit To Practice Public Accounting - Oregon Board Of Accountancy Page 4

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Oregon Board of Accountancy Employment Record

This form is part of the application for certification and the completed form must be returned to the Oregon Board of Accountancy with your application. Include additional

pages if necessary. Please type or print. Experience and exam requirements must be completed within eight years immediately preceding the date of this application.

Directly

Type

10‐YR Employment

√

Supervised

Employer

Complete Address of Employer,

Phone Number

Record

CPA

List all employers for previous 10

include contact person’s name.

Include periods of unemployment.

Attest

Other

Industry

PA?

Leave no gaps in dates of employment

years beginning with earliest

Prof

Gov’t or

From/To

Yes/No

Stds

Other

ATTEST/ASSURANCE: Employment with a CPA or PA whose practice includes public accounting services using auditing and accounting skills and issuance of reports on financial

services.

OTHER PROFESSIONAL STANDARDS: Professional services performed in accordance with other standards, including consulting services, tax practice, financial planning, internal

audits, government finance management, and regulatory agencies.

INDUSTRY GOVERNMENT: Experience may be obtained while the applicant is employed in industry, government or other settings under the direct supervision of a qualified

supervisor licensee. Industry, government or other experience should demonstrate an understanding of the industry in which the entity operates, including the employer’s

competition (or other similar service providers in the case of government) and key competitive factors that affect the industry. This experience is evaluated on a case‐by‐case

basis to ensure that it is equivalent to public accounting experience.

Signature

Date

Print Name

2016 INITIAL CPA APPLICATION PAGE 2