Fillable VERIFICATION OF WORK EXPERIENCE (MyFloridaLicense)

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VERIFICATION OF WORK EXPERIENCE (MyFloridaLicense)

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Page 1 of 2
DBPR CPA 32 CPA Work Experience Eff. Date: May 2019 Incorporated by Rule: 61H1-27.0041 F.A.C.
State of Florida
Department of Business and Professional Regulation
Board of Accountancy
Verification of Work Experience
Form # DBPR CPA 32
VERIFICATION OF WORK EXPERIENCE
INSTRUCTIONS – Please complete and sign the "Applicant Information" section and forward to your
verifying CPA for completion and return to the Department of Business and Professional
Regulation.
I hereby authorize my employers (past and present) to release to the Florida Board of Accountancy any information,
files and/or records as it may deem necessary in the processing of this verification of work experience.
APPLICANT INFORMATION
Last Name First Middle
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
Date
Applicant's Signature
EMPLOYER INFORMATION
Name of Employer
Location of office in which applicant was employed
VERIFICATION PERIOD
(Give complete details below. Attach additional statement if necessary.)
FULL-TIME EMPLOYMENT:
Date From: To:
Number weeks employed
Applicant still employed: YES NO
Average hours per week employed
Total hours employed
PART-TIME EMPLOYMENT:
Date From: To:
Number weeks employed
Applicant still employed: YES NO
Average hours per week employed
Total hours employed
Page 2 of 2
DBPR CPA 32 CPA Work Experience Eff. Date: May 2019 Incorporated by Rule: 61H1-27.0041 F.A.C.
INSTRUCTIONS TO VERIFYING CPA – Please complete and forward this Verification of Work Experience
form to the Department of Business and Professional Regulation,
2601 Blair Stone Rd, Tallahassee, Florida 32399.
I, the undersigned, state that the applicant named on this certification:
has had one year of work experience which included providing any type of service or advice involving the use of
accounting, attest, compilation, management advisory, financial advisory, tax, or consulting skills. This experience
was gained through employment in government, industry, academia, or public practice and constituted a substantial
part of the applicant’s duties.
has had at least five years of work experience, after licensure as a CPA or Canadian, Mexican, Irish, Australian,
New Zealand, or Hong Kong Chartered Accountant, which included providing any type of service or advice involving
the use of accounting, attest, compilation, management advisory, financial advisory, tax, or consulting skills. This
experience was gained through employment in government, industry, academia, or public practice and constituted a
substantial part of the applicant’s duties.
I state that these statements are true and correct and recognize that providing false information may result in
disciplinary action against my license or criminal penalties pursuant to sections 455.2275 and 837.06, Florida
Statutes.
Verifying CPA’s Name __________________________________________________________________________
CPA License Number _____________________ Date Original License to Practice Issued _____________________
State in which certified ___________________ Expiration Date of License ________________________________
DATE SIGNATURE OF VERIFYING CPA
Is there any additional information concerning the good moral character or technical fitness of the employee relative
to his/her practice of public accounting that you feel the Board should be informed of? Yes No
(If "Yes", please attach written explanation.) Good moral character means a "personal history of honesty, fairness,
and respect for the rights of others and the laws of this state and nation."
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VERIFICATION OF WORK EXPERIENCE (MyFloridaLicense)

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Completed 11 February 2021

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