Experience Certification Form, Sample 3

Atlantic School of Chartered Accountancy.

Experience Certification Forms - Sample #3

EXPERIENCE CERTIFICATION FORM
This form should be completed by the student and submitted to ASCA for each of the following situations. Please indicate which applies in this instance.
On completion of practical experience period		On completion of experience obtained prior to receiving university degree
On termination of employment		On completion of recognized co-op work term
Note - discounting of 50% applies to experience received prior to obtaining 60 credit hours in the degree program. The 50% discount does not apply to Co-op students in NS, NF or PEI.

^{Student surname followed
by given names (Print)}

^Employer

^Address

	Day	Month	Year
Date of employment in this office or registration as a student, if later.	01	01	07
Current date or date employment ended	27	04	07

30 MONTH REQUIREMENT (129 WEEKS)
Length of time employed in this office Time should be reported in weeks with five standard days equalling one week. Report one standard day as .2, two days as .4, (i.e., one week and three days should be reported as 1.6 weeks). One month equals 4.3 weeks		Weeks 17
Less Summer school courses	Weeks
Additional time away from work as a result of study and exam days
Uniform Evaluation preparation and writing time
Any other paid or unpaid leaves of absence that have not been reported above (may include illness/bereavement/compassionate/vacation/maternity) over the maximum period permitted. See ASCA Information Handbook.
Total to be deducted from length of time employed in this office
Net length of time employed in this office		17
Plus: Recognized experience from previous employment (if applicable)
Total length of time employed		17

CHARGEABLE HOUR REQUIREMENTS
	Attestation	Review	Total Attestation and Review	Tax	Other	Total
Minimum chargeable hours required	*625*		*1250*	*100*		*2500*
Chargeable hours as recorded on the Experience Record	31	*214*	*245*	69	*286*	*600*
Chargeable hours brought forward from previous employment (previously reported to ASCA)
Total Chargeable Hours Completed	31	*214*	*245*	69	*286*	*600*

CERTIFICATION

Student Certification

I, certify the information provided on this form is accurate.
Name of student (please print)

Signature of Student

Date

Employer Certification

To the best of my knowledge and belief, the information provided above relating to the period of experience claimed in this office is correct in all respects.

Name of Member (Please Print)

Signature of Member

Date

For ASCA use only

____________________________________
Approved