Personal Reference Form - Minnesota Board Of Accountancy
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1M
B
a
Ph: 651-296-7938
innesota
oard of
ccountancy
CLEAR
CLEAR
Fax: 651-282-2644
85 East 7th Place, Suite 125
FORM
FORM
boa.state.mn.us
St. Paul, MN 55101-2143
PERSONAL REFERENCE FORM
Instructions for Applicant:
Complete the first three fields, then send this form to your reference.
Name of Reference
Address of Reference
has applied to the Minnesota Board of Accountancy for a CPA license.
(Name of Applicant)
Instructions for Reference:
The applicant has listed you as a personal reference. Please provide the following
information and return this form to the Board office at the address shown above. Failure to do so may delay
the processing of the application. Thank you for your assistance.
How long have you known the applicant?
In what capacity have you known the applicant?
Is the applicant related to you?
Do you consider the applicant honest in every respect?
Yes
No*
Is the applicant reliable?
Yes
No*
Is the applicant trustworthy?
Yes
No*
Have you employed or supervised the work of the applicant at any time?
Yes
No
If so, was the applicant’s work satisfactory?
Yes
No*
Have you had sufficient personal contact with the applicant to enable you to serve
Yes
No*
as a reference?
Do you know of any reason the applicant should not be granted a CPA license?
Yes*
No
*If you checked a box with an asterisk (*) provide an explanation below or attach a separate sheet.
Signature of Reference
Date
Phone Number
Important:
This completed form should be sent by the reference directly to the Board office (see contact
information above). Do not return to the person seeking the reference.
To serve as a reference, you should have known the person for at least 2 years, feel you can attest to their
professional qualifications, and not be related to them.
Personal Reference FORM—Page 1 of 1
Rev 02/17
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