New Jersey Office of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Accountancy
124 Halsey Street, 6th Floor, Newark, NJ 07102
Phone Number: (973) 504-6380
1. I am a (an):
_____ CPA examination successful candidate
_____ Applicant for endorsement, certified in the state of ___________________________________
2. Name (legal) to appear on my certificate/license:
__________________________________________________________________________________
3. Current home address:
__________________________________________________________________________________
Street
County
__________________________________________________________________________________
City
State
Zip
4. Home telephone number: (______) _______-________
5. Business telephone number: (______) _______-________
6. Email Address ___________________________________
7. Signature of applicant: ___________________________________
8. Date: __________________
9. List of all employment:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Important - All employment must be supported by a statement of experience.
New Jersey Office of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Accountancy
124 Halsey Street, 6th Floor, P.O. Box 45000
Newark, New Jersey 07101
(973) 504-6380
Application for Licensure as a Certified Public Accountant
Date of birth: _______________________
Date : ____________________________
A nonrefundable application filing fee (see box above to th