Part A - Initial Salesperson License Application Form
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Louisiana Real Estate Commission
Post Office Box 14785
Baton Rouge, LA 70898-4785
1-800-821-4529 (in state only) or (225) 925-1923
PART A
INITIAL SALESPERSON LICENSE APPLICATION ___ Resident ___Non-resident
Initial salesperson license fee remit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $45.00
Add Research and Education Fund fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . $10.00
Add Recovery Fund Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . $10.00
Application Processing Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . $25.00
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $90.00
Remit total fee of $90.00 to the Louisiana Real Estate Commission. Checks are accepted.
_________________________________________________________________________________________
1. Resident of
Parish/County: _________________________________________
2. Name: _________________________________________________________________________________
(First)
(Middle)
(Last)
3. Physical Address: ________________________________________________________________________
(Mandatory)
(Street)
(City)
(State)
(Zip)
4. Mailing Address: ________________________________________________________________________
(If different from Physical)
(Street)
(City)
(State)
(Zip)
5. Business Telephone: (
)
Home Telephone: (
)_____________________
⌂
⌂
6. Date of Birth:
/
/
Male
Female
⌂
⌂
7. Are you an American citizen?
Yes
No If no, list Alien registration number: __________________
8. Are you currently, or have you ever been licensed as a salesperson or broker in Louisiana or any other state?
⌂
⌂
Yes
No
List the name(s), date(s), and state(s) in which each license was issued. Use an attachment if necessary.
(a) _________________________________________________________________________________
(b) _________________________________________________________________________________
(c) _________________________________________________________________________________
You must attach a license verification from each state in which you were previously licensed.
9. Have you ever had a salesperson or broker license denied, censured, suspended, or revoked in Louisiana or
⌂
⌂
any other state?
Yes
No If yes, furnish letter of detail with this application.
10. Have you ever been convicted, pled guilty or nolo contendere to the crimes of forgery, embezzlement,
obtaining money under false pretenses, larceny, extortion, conspiracy to defraud, theft, or any crime of
⌂
⌂
moral turpitude?
Yes
No If yes, furnish letter of detail with this application.
11. Have you ever been convicted, pled guilty or nolo contendere to any felony crime in any court of
⌂
⌂
competent jurisdiction?
Yes
No If yes, furnish letter of detail with this application.
12. Name the institution from which you received your high school diploma or certificate of equivalency:
___________________________________________________________________________________
Name of Institution
City
State
Graduation Date
13. Attach proof (certificates and/or transcripts) of 90 hours of prerequisite course work approved by the
Louisiana Real Estate Commission.
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