Cpa Form 11A 5 PDF Details

Are you a small business owner who is looking for a way to reduce your taxes? If so, you may be considering using a cpa form 11A 5. However, before you do, it's important to understand what this form is and how it can help you. In this blog post, we will discuss the basics of cpa form 11A 5 and explain how it can benefit your small business. We will also provide some tips on how to use this form correctly. So, if you're interested in learning more about cpa form 11A 5, keep reading!

QuestionAnswer
Form NameCpa Form 11A 5
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namescpaapp cpa form 11a 5

Form Preview Example

Application for Certified Public Accountant License

Form 11A-5 (Revised 2/12)

Purpose:

To provide information required to process your application.

 

 

Applicability:

Type A, B, C, D and E applicants (see reverse).

 

 

Required Action:

Complete the document in its entirety, affix a 2” x 2” passport size

 

photo, and submit with a fee of $250, payable to the California Board of

 

Accountancy.

 

 

When:

Upon passage of the Uniform CPA Exam and obtaining requisite

 

experience.

 

 

Submit To:

California Board of Accountancy

 

2000 Evergreen Street, Suite 250

 

Sacramento, California 95815-3832

 

 

Authority:

Business and Professions Code Section 5080.

 

TYPES OF LICENSURE APPLICANTS

Type A

An applicant who passed the Uniform CPA Exam in California and is

 

applying for licensure as a CPA in California for the first time.

Type B

An applicant who passed the Uniform CPA Exam in a state other

 

than California and has not been issued a valid license to practice

 

public accounting in any state and is applying for licensure as a CPA in

 

California for the first time.

Type C

An applicant who passed the Uniform CPA Exam in a state other

 

than California and was issued a valid license to practice public

 

accounting in a state other than California.

Type D

An applicant who previously was licensed as a CPA in California and

 

the certificate was cancelled after five years for nonpayment of license

 

renewal fees.

Type E

An applicant who passed the Canadian Chartered Accountant Uniform

 

Certified Public Accountant Qualification Examination (CAQEX) of the

 

American Institute of Certified Public Accountants (AICPA) or the

 

International Uniform Certified Public Accountant Qualification

 

Examination (IQEX) of the AICPA and the National Association of State

 

Boards of Accountancy (NASBA).

Type F

A California licensee originally issued a license to perform general

 

accounting services who has now completed attest experience.

APPLICATION FOR CERTIFIED PUBLIC ACCOUNTANT LICENSE

APPLICATION PROCESSING FEE $250

SECTION I – LICENSE SELECTION

A.I passed the examination as a California candidate (exclude Section III).

B.I passed the examination as a candidate of a state other than California, and I have not been issued a valid license in any state (exclude Section III).

C.I passed the examination as a candidate of a state other than California and was issued a valid license to practice public accounting in a state other

than California.

D. I was once licensed in California. My certificate number was. My

CPA certificate was cancelled due to nonpayment of fees (exclude Section III).

E.I passed the CAQEX/IQEX examination (exclude Sections III & IV).

In this space, glue a recent 2” x 2” passport size and quality photograph showing only your head and shoulders

SECTION II – PERSONAL INFORMATION

1.Full name (no initials)

Last

First

Middle

2.List other name(s) known by

3.Residence address

DO NOT WRITE IN THIS SPACE

License No.

Date Issued

 

 

 

 

Street and Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

State

 

 

Zip Code

4.

Telephone No.

(

 

)

 

 

(

)

 

 

 

Area Code

 

 

Office Number

Area Code

 

Home Number

5.E-mail address (optional)

6.

U.S. Social Security #

 

7. Birthdate

8.Current occupation

9.Current employer’s name

10.Employer’s address

 

City

 

State

 

Zip Code

 

CPA Exam Unique

 

 

 

 

 

11.

Identifier # (if applicable)

 

12. Date CPA Exam passed

 

State

 

Have you ever had a professional or vocational license, permit, certificate or registration disciplined, cited or received any

13.other form of enforcement action by this or any other state or a foreign country? (CHECK ONE) Yes No

(IF THE ANSWER TO QUESTION 13 IS “YES” EXPLAIN FULLY, USING A SEPARATE SHEET OF PAPER)

SECTION III – OUT-OF-STATE LICENSEE INFORMATION

14.In which state(s) were you issued a CPA or PA license, permit, certificate, or registration? CPA Certificate/License No(s).

Date(s) CPA Certificate/License(s) Issued

11A – 5 (Rev. 2/12)

SECTION IV – EDUCATION

List all schools attended after high school

Indicate No. of Years Attended

(check one)

 

 

 

Degree

Junior or

4-year

Business

Obtained?

Community

College or

School

Yes

No

College

University

 

 

 

 

 

 

SECTION V – PATHWAY CHOICE

Select a licensure pathway (check one)

Pathway 1 – with attest experience – requires 24 months of experience.

Pathway 1 – without attest experience – requires 24 months of experience.

Pathway 2 – with attest experience – requires 12 months of experience.

Pathway 2 – without attest experience – requires 12 months of experience.

SECTION VI – EXPERIENCE

List below, in chronological order, all public and nonpublic experience for which you will have a General or Attest Certificate of Experience submitted. You are responsible for providing each supervisor with a Certificate of Experience for completion. The supervisor must return the General or Attest Certificate of Experience directly to the California Board of Accountancy.

Experience – List the employers who will be submitting a General or Attest Certificate of Experience.

POSITION

(Dates)

 

EMPLOYER

Public (P)

MAILING ADDRESS

FROM

 

TO

Nonpublic (NP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OUT-OF-STATE CPA LICENSEES ONLY: For self-employment experience, submit a schedule listing the following

information: (1) Names and addresses of your clients. (2) A brief description of the type of services rendered to the client. (3) Dates services performed.

SECTION VII – CERTIFIED TRUE STATEMENT

I hereby certify, under penalty of perjury, under the laws of the state of California that all statements, answers, and representations on this form, and all attachments, are true, complete, and accurate.

Date

 

Signature

NOTICE: Effective July 1, 2012, the State Board of Equalization (BOE) and the Franchise Tax Board (FTB) may share taxpayer information with the CBA. You are required to pay your state tax obligation and your license may be suspended or your renewal application denied if the state tax obligation is not paid and your name appears on either the BOE or FTB certified list of top 500 tax delinquencies.

-2-

PERSONAL INFORMATION COLLECTION AND ACCESS

The information provided in this form will be used by the California Board of Accountancy, to determine qualifications for a Certified Public Accountant License. Sections 5080 through 5095 of the Business and Professions Code authorize the collection of this information. Failure to provide any of the required information is grounds for rejection of the application as being incomplete.

Information provided may be transferred to the Department of Justice, a District Attorney, a City Attorney, or to another government agency as may be necessary to permit the Board, or the transferee agency, to perform its statutory or constitutional duties, or otherwise transferred or disclosed as provided in Civil Code Section 1798.24.

Each individual has the right to review his or her file, except as otherwise provided by the Information Practices Act. Certain information provided may be disclosed to a member of the public, upon request, under the California Public Records Act.

The Executive Officer of the California Board of Accountancy is responsible for maintaining the information in this application, and may be contacted at 2000 Evergreen Street, Suite 250, Sacramento, CA 95815, telephone number (916) 263-3680 regarding questions about this notice or access to records.

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1. The Cpa Form 11A 5 usually requires specific details to be inserted. Be sure that the subsequent fields are finalized:

Stage no. 1 for filling in Cpa Form 11A 5

2. Right after finishing the last section, go to the next part and fill out the essential details in all these fields - State, Zip Code, Date CPA Exam passed, State, US Social Security Current, City, CPA Exam Unique Identifier if, Have you ever had a professional, Yes, IF THE ANSWER TO QUESTION IS YES, SECTION III OUTOFSTATE LICENSEE, In which states were you issued a, and A Rev.

Find out how to fill in Cpa Form 11A 5 portion 2

People generally make mistakes while completing SECTION III OUTOFSTATE LICENSEE in this part. Ensure you read twice whatever you type in right here.

3. Your next stage is normally straightforward - fill out every one of the fields in List all schools attended after, Business School, College, Junior or Community, College or University, Yes, SECTION V PATHWAY CHOICE, Select a licensure pathway check, Pathway with attest experience, SECTION VI EXPERIENCE, List below in chronological order, Experience List the employers who, EMPLOYER, Nonpublic NP, and Dates to complete the current step.

List all schools attended after, Nonpublic NP, and SECTION VI EXPERIENCE in Cpa Form 11A 5

4. You're ready to start working on this fourth section! Here you have all these Experience List the employers who, EMPLOYER, Nonpublic NP, FROM, MAILING ADDRESS, OUTOFSTATE CPA LICENSEES ONLY For, SECTION VII CERTIFIED TRUE, I hereby certify under penalty of, and Signature blanks to do.

I hereby certify under penalty of, MAILING ADDRESS, and FROM of Cpa Form 11A 5

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