Name_______________________________________________________________________
E-mail Address_____________________________________________________________________
Home or Secondary Address
___________________________________________________________________________
City, State, Zip________________________________________________________________________
Home or Secondary Phone Number _______________________________________________________
Month of your Birth ________________
Referred by_________________________________________
Are you certified? ____ Yes ____ No If Yes, ______ FPC? ____CPP? ____CPA?
Are you a member of the National American Payroll Association? ____ Yes ____ No
Are you interested in becoming a CPP or FPC? _____________________________________________
Would you be interested in volunteering for a committee?
____________________________________
About your Employer and Job:
Employer ____________________________________
Job Title_________________________________
Work Address _________________________________________________________________________
City, State, Zip_________________________________________________________________________
Work Phone Number ______________________ Work Fax Number _____________________
About your Payroll:
How do you process your payroll?
Outsource? ____ Yes ____ No If so, which vendor? ________________________________
In-house?_______ If so, what Software?_________________________________________
Do you have a Time and Attendance System: ____ Yes ____ No
If so, what Software? _____________________
What is the size of your: Payroll? ____________
Number of Employees in the Payroll Dept.? _______
Do you pay employees in: Single State? ________ International Employees? ___________
Multi-state? __________ If multi-State, how many states? _______
