Certificate of General Experience Form 11A-30 (Revised 01/22)
Purpose: The Certificate of General Experience is to document evidence of an applicant’s general
accounting experience.
Applicability: Type A, B, C and E applicants
Types of Licensure Applicants:
Type A – An applicant who passed the Uniform CPA Exam in California, has not been issued a valid
license t
o practice public accounting in any state and is applying for licen
sure 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 pra
ctice public accounting in any state and is applying for licen
sure
as a CPA in California fo
r the first time. Has completed a baccalaureate or is within 6 m
onths of
completion prior to sitting for the CPA Exam in another state.
T
ype C – An applicant who was issued a valid license to practice public accounting in a state oth
er
than Califor
nia.
Type D – An applicant who previously was licensed as a CPA in California and the certificat
e was
cancelled
after five years for nonpayment of license renewal fees.
Type E – An applicant who passed the International Uniform Certified Public Accountant Qualification
Exa
mination (IQEX) of the AICPA and the National Association of State Boards of
Accountancy
(NASB
A).
Type F - A California licensee originally issued a license to perform general accounting services w
ho
has now co
mpleted attest experience
Who Completes this Form: The licensed CPA holding a valid license to practice public accounting
who supervised the applicant’s performance of services provided.
Required Action: Complete and verify your supervision of the applicant’s experience.
When to Complete this Form: Upon the applicant’s request. Failure to submit the Certificate of
General Experience is viewed by the California Board of Accountancy as an attempt to impede the
applicant’s certification and may result in disciplinary action.
Where to Send this Form:
California Board of Accountancy
2450 Venture Oaks Way, Suite 300
Sacramento, CA 95833
Authority for this Form: Business and Professions Code Sections 5092, 5093, 5095, and Sections
12 and 12.5 of Title 16, Division 1 of the California Code of Regulations.
STATE OF CALIFORNIA – BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY GAVIN NEWSOM, GOVERNOR
California Board of Accountancy
2450 Venture Oaks Way, Suite 300
Sacramento, CA 95833
phone:
(916) 263-3680
fax:
(916) 263-3675
web:
www.cba.ca.gov
CERTIFICATE OF GENERAL EXPERIENCE
PRINT OR TYPE
FULL NAME OF APPLICANT: (No Initials) (First) (Middle) (Last) SOCIAL SECURITY #
(Last 4 only)
XXX-
XX-
PERIOD OF EMPLOYMENT
List the dates applicant was under your supervision and obtained qualifying general accounting experience, as defined below.
FULL TIME FROM TO
DATES (mm/dd/yyyy) (mm/dd/yyyy)
/ / / /
PAR
T
-TIME FROM TO
DATES (mm/dd/yyyy) (mm/dd/yyyy)
/ / / /
TOTAL PART-
TIME HOURS
General accounting experience may include providing any type of service or advice involving the use of accounting, attest, compilation,
management advisory, financial advisory, tax or consulting skills. To qualify, experience shall have been performed in accordance with
applicable professional standards.
If an applicant is performing attest services as part of the general experience, it must be performed under the supervision of a licensee who
has satisfied the attest experience requirement.
An applicant who obtains licensure without satisfying the attest experience requirement (Section 12.5 of Title 16 of the
California Code of Regulations) cannot sign reports on attest engagements of any kind until the attest experience requirement
is completed and authorization is given by the California Board of Accountancy (CBA).
BUSINESS NAME: BUSINESS TELEPHONE: Area Code ( )
ADDRESS: (Include City, State, and Zip Code)
Section 12 of the California Code of Regulations requires that public accounting experience be verified by the licensee supervising the
experience. Supervised experience means that the applicant’s supervisor shall have reviewed and evaluated the applicant’s
qualifying work on a routine and recurring basis and shall have authority and oversight over the applicant.
I hereby certify, under penalty of perjury under the laws of the state of California, that the applicant has (1) been supervised or employed
by me or my firm for the period indicated herein, and (2) has completed general accounting experience.
SIGNATURE (Supervisor)
SOLE PROPRIETOR
PARTNER
SHAREHOLDER
OTHER CPA
CERTIFICATE NO. ___________________
U.S. STATE OR OTHER AUTHORITY OF ISSUANCE
☐
☐
☐
☐
CPA
☐
PA
☐
______________
PRINTED NAME
DATE
11A-30 (Rev. 01/22)
PERSONAL INFORMATION COLLECTION AND ACCESS
The information provided in this form will be used by the CBA, 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 CBA, 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 CBA is responsible for maintaining the information in this
application, and may be contacted at 2450 Venture Oaks Way, Suite 300, Sacramento, CA
95833, telephone number (916) 263-3680 regarding questions about this notice or access to
records.
11A-30 (Rev. 01/22)
