Fillable North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

Fill Online, Printable, Fillable, Blank North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners) Form

Use Fill to complete blank online NC STATE BOARD OF CPA EXAMINERS (NC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

On average this form takes 56 minutes to complete

The North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners) form is 9 pages long and contains:

  • 0 signatures
  • 27 check-boxes
  • 211 other fields

Country of origin: US
File type: PDF

U.S.A. forms for NC State Board of CPA Examiners

BROWSE NC STATE BOARD OF CPA EXAMINERS (NC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
APPLICATION PACKAGE FOR REINSTATEMENT OF NC CPA CERTIFICATE
TO ACTIVE STATUS FROM INACTIVE STATUS
Attached is an application for reinstatement of a North Carolina CPA certificate to active status
from inactive status. To ensure that you have enclosed all necessary information and that the
forms are completed correctly, please review the list below before returning the application
package to the Board. All forms must be completed and submitted with the application or the
entire application package will be returned to you. Please keep a copy of all documents for your
reference.
Application Form
• Did you answer all questions?
• Did you sign and date the application?
• Is the application properly notarized?
• Did you enclose a $100.00 check payable to the NC State Board of CPA Examiners or a
$100.00 credit card authorization?
Certificate of Moral Character – You must submit three (3) forms, one (1) form is included in
this package.
• Did a properly licensed CPA complete each form?
• Did you answer all questions?
• Is your name and address on all forms?
• Is each form properly notarized?
You must disclose all convictions, except those that have been expunged, regardless of when
those convictions occurred, to the individuals signing your moral character forms. Those
individuals must indicate knowledge of these convictions on the second page of the form.
Certificates of moral character are valid for one (1) year after being signed.
Continuing Professional Education (CPE) Reporting Form
• Did you list at least 2000 minutes of CPE completed within the last 12 months?
• Did you attach a copy of the certificate of completion for each course?
• Did you attach proof of completion for the NC Accountancy Law Course?
• Did you sign the form?
CPA Firm Registration - If you are in the public practice of accounting as defined in 21 NCAC
08A .0307 and .0308, and the CPA firm through which you are providing services is not
registered with the Board, you must register that CPA firm with the Board. CPA firm registration
forms are available from the Forms & Applications page of the Board’s website, nccpaboard.gov.
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
ACCOUNTANCY LAW COURSE REQUIREMENT
Pursuant to 21 NCAC 08F .0504 and 21 NCAC 08H .0101(a), all North Carolina CPA
certificate applicants and reinstatement applicants must complete a qualified
accountancy law course on the North Carolina Accountancy Law (Statutes) and
Administrative Code (Rules).
To satisfy the requirement, an applicant must complete the course within one year
preceding the date the Board receives his or her application. For example, if you plan to
apply for licensure in February, then you should take the course no earlier than March
of the prior year. If an applicant meets the requirement prematurely, the course will not
count for certification or reinstatement. The Board suggests that an applicant take the
course within a few months prior to submitting his or her application to the Board.
For new CPA certificate applicants, the course will qualify for 400 CPE credit minutes
that may be reported on the CPE renewal form if completed during the same
calendar year in which the certificate is granted.
The North Carolina Association of CPAs (NCACPA) course, "NC Accountancy Law
Course: Ethics Principles and Professional Responsibilities," is the qualified course
that is available in two formats: a 400-minute group study seminar and a
400-minute self-study course.
"NC Accountancy Law Course: Ethics, Principles, and Professional Responsibilities"
NCACPA
PO Box 80188
Raleigh, NC 27623-0188
(919) 469-1040
(800) 722-2836
www.ncacpa.org
PLEASE NOTE THAT THE BOARD DOES NOT OFFER THIS COURSE.
*E
ffective January 1, 2020, CPE credit is calculated in minutes. One CPE hour
equals 50 CPE minutes. An eight-hour CPE course equals 400 minutes.
*
*
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
APPLICATION FOR REINSTATEMENT OF NORTH CAROLINA CPA CERTIFICATE
NC Certificate No:
Other Active Certificate Numbers and Issuing Jurisdictions:
Full Name (First/Middle/Last Suffix)
Home Address (Street or PO Box and City, State, Zip Code)
Home Telephone Number Home Email Address
Business/Firm Name
Business Address (Street or PO Box and City, State, Zip Code)
Business Telephone Number Business Fax Number
Business Email Address Job Title
Send mail to (check one): Home Business
OCCUPATION (check one):
Individual Practitioner Educator Govt., Non-Accounting
CPA Firm-Partner Industry, Accounting Field Law
CPA Firm-PC Shareholder/PLLC Member Industry, Non-Accounting Student
CPA Firm-Staff Govt., Accounting Unemployed
AREA OF CONCENTRATION (check one):
General Accountancy Auditing Financial Planning
Taxation Advisory Services Non-Accounting
Administration Law
Check the memberships you hold in the following organizations:
North Carolina Association of CPAs American Institute of CPAs
FOR BOARD STAFF USE: Amt Paid Dep. # Date
01-2020
Employee Fair Classification Act
The 2017 Session of the North Carolina General Assembly passed Senate Bill 407 (Session Law
2017-203), “Employee Fair Classification Act.”
§143-761. Title. This Article shall be known and may be cited as the "Employee Fair Classification
Act."
§143-765. Occupational licensing boards and commissions; notice requirement; applicant
certification and disclosure.
(a) Every State occupational licensing board or commission that is authorized to issue any
license, permit, or certification shall include on every application for licensure, permit, or certification,
or application for renewal of the same, the following:
(1) Certification by the applicant that the applicant has read and understands the public notice
statement.
(2) Disclosure by the applicant of any investigations for employee misclassification and the result
of the investigations for a time period determined by the occupational licensing board or
commission.
(b) An occupational licensing board or commission shall deny the license, permit, or certification
application of any applicant who fails to comply with the certification and disclosure requirements of
this section.
Public Notice Statement
Required by NC Gen. Stat. §143-764(a)(5), effective December 31, 2017.
Any worker who is defined as an employee by NC Gen. Stat.§§95-25.2(4), NC Department of Labor;
143-762(a)(3), Employee Fair Classification Act; 96-1(b)(10), Employment Security Act; 97-2(2),
Workers Compensation Act; or 105-163.1(4), Withholding; Estimated Income Tax for Individuals;
shall be treated as an employee unless the individual is an independent contractor. Any employee
who believes that the employee has been misclassified as an independent contractor by the
employee’s employer may report the suspected misclassification to the Employee Classification
Section within the North Carolina Industrial Commission.
Employee Classification Section
North Carolina Industrial Commission
1233 Mail Service Center
Raleigh, NC 27699-1233
Telephone: (919) 807-2582
Fax: (919) 715-0282
Email: emp.classification@ic.nc.gov
Employee misclassification is defined as avoiding tax liabilities and other obligations imposed by
Chapter 95, 96, 97, 105, or 143 of the North Carolina General Statutes by misclassifying an
employee as an independent contractor [NC Gen. Stat. §143-762(5)].
I certify that I have read and understand the Public Notice Statement: Y N
I certify that I have not ever been investigated by any agency for employee misclassification: (If you
answer no, attach documents applicable to the investigation(s) with this application.) Y N
Signature Date
1-2020
I am enclosing certificates of moral character prepared under oath by the following three CPAs:
1.
2.
3.
Moral Character Data: If you answer "Yes" to any of the questions below, you must provide a certified copy of the court records or a
certified copy of the applicable license or disciplinary records with your statement of explanation with this application.
Have you ever been charged, arrested, convicted, found guilty of, received a prayer for judgment continued, or pleaded
nolo contendere to any offense inclusive of traffic infractions? If yes, please attach copy of relevant
documents. You are not required to disclose any arrest, charge, or conviction that has been expunged by the court.
Y N
Have you had an application for certificate or license denied or certificate or license suspended, canceled, or revoked
by any state or federal agency or governing or licensing board?
Y N
Have you been investigated, charged, or disciplined; or are you currently under investigation by a governing or
licensing board or by a state or federal agency?
Y N
Have you been party to any civil suit, bankruptcy action, administrative proceeding, or binding arbitration; the basis of
which is grounded upon an allegation of negligence, dishonesty, fraud, misrepresentation, or incompetence?
Y N
NOTE: All required forms must be completed and enclosed with your application or the entire application package will be
returned to you.
APPLICATION FEE: Enclose a $100 check payable to the NC State Board of CPA Examiners or a $100 credit card
authorization.
AFFIDAVIT OF APPLICANT
I have read General Statutes Chapter 93 and Title 21, North Carolina Administrative Code, Chapter 08 and do understand the law and
rules of the Board applicable to all certified public accountants, particularly those about Professional Ethics and Conduct, and, the
Continuing Professional Education requirements. As far as I am able to determine, I meet all of the requirements to apply for
reinstatement of my North Carolina CPA Certificate. I understand the contents of applications including all attachments and disciplinary
actions or consent orders regarding me are subject to the NC Public Records Act. I understand that I am waiving any claim of
confidentiality or privacy regarding disclosure of such public records. I authorize the Board to make such investigative inquiries it
deems necessary and release from liability all parties responding to such inquiries. I affirm under the penalties of perjury that the
information, statements, and any attachments made in conjunction with this application are true, correct, and complete.
Signature Date
State
County
Signed and sworn to (or affirmed) before me this day by .
(Name of Applicant for Reinstatement)
Witness my hand and official seal, this the day of , 20 .
Official Signature of Notary
, Notary Public
Notary’s printed or typed name
My commission expires: .
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
CERTIFICATE OF MORAL CHARACTER AND ELIGIBILITY - CPA CERTIFICATE APPLICANTS
TO BE COMPLETED BY APPLICANT:
Original CPA Certificate Applicant Reinstatement of CPA Certificate Reissuance of CPA Certificate
Full Name (First/Middle/Last/Suffix)
Mailing Address (Street or PO Box)
City, State, Zip Code
REMAINDER TO BE COMPLETED BY CPA SIGNING FORM (Please print legibly using blue or black ink.):
INSTRUCTIONS: NCGS 93-12(5) requires applicants for the CPA certificate to have good moral character. CPAs
completing this form are asked to evaluate and comment upon the applicant's character, conduct, social relations, and
adherence to general principles of right conduct. A CPA is expected to hold a high sense of duty to his/her fellow man and
to society in general because of the amount of trust and confidence that will be placed in him/her by clients and by the
citizens of this State and Nation.
Suggested references must be CPAs and may include, but are not restricted to, instructors/professors, employers, fellow
employees, fellow NCACPA chapter members, neighbors, and public officials. The Board will not accept references from
persons related by blood or marriage to the applicant. Persons signing moral character certificates are expected to have
known the applicant for a sufficient period of time to make an evaluation of his/her moral character and to be familiar with
the applicant's lifestyle outside of the classroom or workplace. Persons signing this form should do so only after careful
consideration, and only after reviewing the properly completed application package to determine that the applicant has
made all required disclosures.
NOTE: Persons completing this form who reside and/or work in North Carolina must be licensed by this Board to
use the CPA title. Completion of this form is considered to be use of the CPA title. Persons not licensed by this
Board and living outside of North Carolina who complete this form must be currently licensed by another board
of accountancy.
I have personally known the applicant for years, months.
Describe in detail the opportunities you have had to evaluate the applicant (Attach additional page if needed).
Is the applicant of good moral character (i.e. has a personal history of honesty, fairness and respect for the rights of others
and for the laws of the State of North Carolina and this nation) and would be expected to conscientiously observe the high
professional responsibilities of a Certified Public Accountant? Y N If no, please explain (Attach additional
page if needed.):
Is the applicant entirely worthy of the trust placed in him/her by the State of North Carolina and the public as a Certified
Public Accountant? Y N If no, please explain (Attach additional page if needed.).
Page 2 of 2
01-2020
To the best of my knowledge, the applicant has never been convicted, found guilty of, received a prayer for judgment
continued, or pleaded nolo contendere to any criminal offense (excluding non-criminal traffic infractions). Y N
If no, please explain (Attach additional page if needed.):
Other Comments:
If you have any questions about the applicant's moral character that are not fully explained on this form, or if the applicant
has disclosed arrest or conviction records, or license denial, suspension, or revocation by any licensing agency, the
person signing this certificate should review the documents to be supplied to the Board with the applicant's application and
send a confidential letter outlining any opinions you have concerning these matters to: Licensing Section, North Carolina
State Board of CPA Examiners, PO Box 12827, Raleigh, NC 27605. Please consider sending such correspondence by
certified mail to ensure its receipt. The Board of CPA Examiners and its staff may communicate with the person signing
this form.
I affirm under the penalties of perjury that the information, statements, and any attachments made in conjunction with this
certificate of moral character are true, correct, and complete.
Date: Signature:
NOTE: If your residence or office is in North Carolina, you cannot sign this form unless you are licensed by this
Board.
(Please print legibly using blue or black ink.)
Reference Name:
Title/Occupation:
Firm/Employer:
Street/PO Box:
City/State/Zip Code:
Daytime Telephone:
Email Address:
CPA Certificate Number and Issuing Jurisdiction:
State
County
Signed and sworn to (or affirmed) before me this day by
(Name of Person Providing Moral Character Reference)
Witness my hand and official seal, this the day of , 20 .
Official Signature of Notary
, Notary Public
Notary’s printed or typed name
My commission expires:
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1423 • Fax 919-733-4209 • Web nccpaboard.gov
REPORT OF CPE FOR REINSTATEMENT OR REISSUANCE OF NC CPA CERTIFICATE
Pursuant to 21 NCAC 08I .0104, 08J .0105, and 08H .0101(d)(3), CPE credit minutes may not be more than 12 months old
for reinstatement or reissuance or 24 months old for reciprocal certification. Pursuant to 21 NCAC 08J .0105(c)(2) and 08F .0504,
400 minutes must be from the NC Accountancy Law Course. Supporting documentation (certificates of attendance or
completion) must be enclosed with this report.
GROUP-STUDY AND SELF-STUDY PARTICIPANT CREDIT
DATE (MM/DD/YY)
ACTIVITY TITLE
SPONSOR
CREDIT MINUTES
GROUP-STUDY INSTRUCTOR CREDIT (NO MORE THAN 1000 MINUTES)
DATE (MM/DD/YY)
ACTIVITY TITLE
SPONSOR
CREDIT MINUTES
PUBLICATION/AUTHOR CREDIT (NO MORE THAN 500 MINUTES)
DATE (MM/DD/YY)
ACTIVITY TITLE
SPONSOR
CREDIT MINUTES
TOTAL MINUTES CLAIMED (including carry-forward minutes)----------------------------------------------------------------------------
I have read the CPE rules of the Board as found in 21 NCAC 08G .0400. I certify that all the CPE that I have taken has enhanced my
professional competence. I certify that the information presented is truthful and correct.
Printed Name Signature
NC CPA Certificate Number Date
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
CREDIT CARD PAYMENT
Credit card payment cannot be processed unless all fields below are complete.
MasterCard VISA Amount $
Card Number
CVV/Security Code Expiration Date
(3-digit code on back of card near or in signature box) (MM/YYYY)
Exact Name on Card
Billing Address for Card
Street or PO Box and City, State, Zip Code
Signature Date
FOR BOARD USE AUTHORIZATION CODE
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document