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GOVERNMENT FINANCE OFFICERS ASSOCATION OF ALABAMA APPLICATION FOR C.G.F.O. PROGRAM |
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| To Government Finance Officers Association Certification Board | ||||||||||
| (Mr. Mrs. Ms.)__________________________________________________________________ | ||||||||||
| Title | Name | |||||||||
| (Applicant check the sub-paragraph that is applicable) | ||||||||||
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I am familiar with the rules and regulations of the Certified Government Finance Officer program and the instructions accompanying this application. As a condition of this application, I pledge full observation of said rules and regulations. If any of these answers to the following questions are false, or if I am guilty of non-disclosure of material information in making this application, I hereby disqualify, myself ipso facto. If any false statement of material non-disclosure remains undiscovered by the Board until after a certificate has been issued to me, I hereby agree to surrender and forfeit the certificate and to deliver it to the Secretary of the Board upon demand being made thereof. I enclose herewith a check made payable to GFOAA for the required fees in the amount of $__________. |
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| 1. Full Name ________________________________________________________ | ||||||||||
| 2. Residence Address ______________________________ | Phone # _____________ | |||||||||
| 3. Business Address _______________________________ | Phone # _____________ | |||||||||
| 4. Are you a citizen of the United States by birth? _______ | By naturalization? _______ | |||||||||
| 5. Present Employer _____________________________________________________ | ||||||||||
| Address __________________________________________ | Position Held __________ | |||||||||
| 6. Place of Birth _____________________________________________________ | ||||||||||
| 7. Social Security Number ____________________________________________ | ||||||||||
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8. Education - List colleges or universities attended and dates of attendance. Attach a transcript of highest degree held. |
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9. Certification - List all professional accounting certifications held including certificates & date issued and status (active or inactive) |
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10. Employment - List a continuous record of all employments and occupations for which you are requesting credit. Give full names and dates and complete present mailing addresses. Attach copy(s) organization charts, supervisors and telephone numbers. |
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11. Professional Involvement - List offices and committee memberships held in organizations which required application of technical expertise. Provide appropriate dates and attach explanation of responsibilities (if needed) to clarify role. |
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12. Have you ever been arrested or convicted of a felony or misdemeanor or declared by any court of competent jurisdiction to have committed any fraud? ____________ If so, give particulars in a letter attached. I certify under penalty of perjury that all statements, answers and representations made in application and all supplementary statements, are true and accurate and that I have not suppressed any information that might affect this application. |
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| Date ___________________ | Signature ______________________________ | |||||||||
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Please return the completed form and payment to: Government Finance Officers Association of Alabama |
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Admission to the examination for Certified Government Finance Officer certificate and upon passing the examination to the satisfaction of the Board and presentation of evidence of sufficient professional experience and compliance with the other requirements of the certified Government Finance Officers Program to have a certificate issued to me entitling me to be known as a Certified Government Finance Officer under the requirements of the Government Finance Officers Association of Alabama. I am requesting to sit for the following part(s) of the examination and agree to pay a fee of $75 per part.