Tax Consultant Application

Name:
SSN:
Present Address (Street, city, state, zip):
Permanent Address (Street, city, state, zip):
Telephone #:
Email:
Are you 18 years of age or older? Yes No
Are you legally eligible for employment in the United States? Yes No

Personal

Date you can start:
Salary desired:
Are you currently employed? Yes No
If so may we contact your present employer? Yes No

Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last 10 years? (Applicant is not obligated to disclose sealed or expunged records of convictions or arrests.) Yes No

If yes, please explain. (Note: A conviction will not necessarily result in the denial of employment.)

Have you previously applied or worked with IPA-IBA? Yes No
If yes, Where: When:
How were you referred?
Have you previously worked for another consulting company? Yes No
If yes, what company?
Date of employment: From To

Education

Education	Name/Location of School	Years Attended	Degree Earned	Subjects Studied
High School		Did you Graduate: Yes No
Undergraduate, College/University		Did you Graduate: Yes No
graduate School, Professional Training

General

Special Skills:

Military/Naval Service: Rank:
Present Membership in National Guard/reserves: Yes No
Do you have an auto? Yes No
If so, Year Model
Do you have auto insurance? Yes No

Employment History

Employer/Company Name: Address: Job title & Duties: Reason for Leaving:	Date Employed From: To: Starting Salary: $ per Ending Salary: $ per
Employer/Company Name: Address: Job title & Duties: Reason for Leaving:	Date Employed From: To: Starting Salary: $ per Ending Salary: $ per
Employer/Company Name: Address: Job title & Duties: Reason for Leaving:	Date Employed From: To: Starting Salary: $ per Ending Salary: $ per

References

Name	Address	Business	Years Acquainted	Email

Text-based Resume:

By submitting this form you agree to the following: "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have and release all parties from all liability for any damage that may result from furnishing same to you. Investigation may include credit and background checks. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause by me or the company."