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Application

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PERSONAL DATA SUMMARY
This Personal Data Summary (PDS) provides an opportunity to present a statement of your qualifications.
Although not required for the initial interview, its careful preparation will help you and our representatives
derive the maximum benefit in the limited time available. Please review our brochures and website (www.rbz.com)
prior to the interview.

Identity Information

Last Name
 First Name
 Middle Initial
 Nickname
Permanent Address
 City
 State
 Zip
 Telephone
Current Address
 City
 State
 Zip
 Telephone
Email
Do you have the legal right to work in the United States? Yes No
Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)? Yes No

Date Availaible

When would you prefer to begin full-time employment?
If you are applying for an internship, please indicate beginning and ending dates of the period you would be available for the program.
Begin: End:

Education
List current or most recent as number 1, next most recent as number 2, etc.

College Name 1.
City, State
Period Attended Month, Year:
From To
Major, Degree, Degree Date
Grade Point Average:
Overall Major A=
Approximate Standing in Class Top
10% 25% 50% 75%
College Name 2.
City, State
Period Attended Month, Year:
From To
Major, Degree, Degree Date
Grade Point Average:
Overall Major A=
Approximate Standing in Class Top
10% 25% 50% 75%
College Name 3.
City, State
Period Attended Month, Year:
From To
Major, Degree, Degree Date
Grade Point Average:
Overall Major A=
Approximate Standing in Class Top
10% 25% 50% 75%

Courses Credits
For courses listed below, please indicate by school 1, 2 or 3 (above) the credit hours you will have at the time you become available for employment. In the grade column, show grades for courses completed, IP for courses in progress or WT for courses you will take prior to graduation.

Accounting and
Related Courses		 School
(1, 2 or 3)		 Credit
Hours		 Grades
Elementary/Intro
Intermediate
Advanced
Auditing
Cost
Taxation
Business Law
Finance
Other Courses School
(1, 2 or 3)		 Credit
Hours		 Grades
Economics
Actuarial Science
Management
CIS/MIS
Other Business
English
Mathematics
Other

Work Experience
List current or most recent first. Include part-time and vacation jobs in excess of one month’s duration.

Employer 1.
Location
Phone Number
Nature of Duties or Title
Period Employed
From: To:
Approx Hours per week
Employer 2.
Location
Phone Number
Nature of Duties or Title
Period Employed
From: To:
Approx Hours per week
Employer 3.
Location
Phone Number
Nature of Duties or Title
Period Employed
From: To:
Approx Hours per week

Test Results
If you have taken any of the following tests, please indicate your results.

College Board Scholastic Aptitude Test (SAT): Verbal (200-800)
 Quantitative (200-800)
 Total (400-1600)
American College Testing Program (ACT): English (1-36)
 Math (1-36)
Composite (1-36)
Graduate Management Admission Test (GMAT): Verbal (0-60)
 Quantitative (0-60)
 Total (200-800)
Law School Admission Test (LSAT): (120-180)
Have you passed the CPA Examination? Yes - No If yes: Date State

College Activities/Community Involvement
Memberships in Honorary Societies. Please note if you are a member or officer:

Beta Alpha Psi: Beta Gamma Sigma:
Golden Key National Honor Society: Other (list):
Please list memberships in student government, fraternity/sorority, student clubs and other organizations, including leadership positions held.

Language Skills
Please indicate your language proficiencies:

Fluent Business Fluent Conversant
French
German
Spanish
Japanese
Other

Independence, Additional Data and Remarks

Independent accountants are subject to certain restrictions regarding the holding of interests in, and positions and associations with, audit clients. These restrictions also apply to relatives of the accountant in varying degrees, depending upon the positions occupied by the accountant and the relative in their respective employments.
If you have any relatives whose relationship to you and their employment should be evaluated for this purpose, please identify them and their affiliations.
Have you been convicted of a misdemeanor or felony?* Yes No - Details
*Convictions will not necessarily disqualify an applicant for the position sought.
Have you previously applied to RBZ, LLP for employment? Yes No
If yes, date of last application: - Office:
Who suggested that you contact us regarding employment?
Please list any other relevant information that we should know as your possible employer.
An offer of employment is subject to verification of the information submitted herein. This form will be part of your personal record if you are employed.
Signature - Date: 05/17/12



RBZ, LLP is an equal opportunity firm. We recruit, employ, train, compensate and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, or veteran status.


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