Form 14145 Form 14145 IRS Applicant Contact Information

IRS Applicant Contact Information
Last name

OMB Number 1545-2240

First name

Are you a citizen of the United States
Yes

No

Street address

ZIP code

Mobile or home telephone number

Email address (permanent)

Check all that apply
Veteran

Military Spouse

First college attended

Sch A Authority / Disability
State

CPA

Bilingual (indicate up to 3 languages)
Degree
Associate

Major

Bachelors

GPA

Second college attended

State

PHD

Law

Degree
Associate

Major

Masters

Year graduated/anticipated (mm-dd-yyyy)

Bachelors

GPA

Masters

PHD

Law

Year graduated/anticipated (mm-dd-yyyy)

To Be Completed by Authorized Personnel ONLY
Recruiter name
Potential
applicant
for

Date
Revenue Agent 0512

Information Technology 2210

Revenue Officer 1169

Economist 0110

LMSB Agent 0512

Student Employment 0099

Tax Compliance Officer 0526

Other

Special Agent 1811

Customer Service Rep. 0962

Attorney 0905

Remarks

Privacy Act and Paperwork Reduction Act Notice
We are authorized to request this information under 5 U.S.C. §§ 301 and I.R.C. §§ 7801 and 7803. We use it to contact potential applicants about jobs when jobs become available. You are not required to give us the information. If you
do not provide the information we ask for, it may delay or prevent our contacting you; providing false or fraudulent information could subject you to penalties. We may disclose this information to the Department of Justice for civil or
criminal litigation.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. The time needed to complete the form will vary depending on
individual circumstances. The estimated average time for completing this form is five minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear
from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave., NW, IR 6526, Washington, DC 20224.

Form 14145 (Rev. 6-2013)

Catalog Number 55038C

www.irs.gov

Department of the Treasury - Internal Revenue Service