Looking for a Illinois Legal Forms And Templates? Download it for free!

Form Il 505-0338 - Application For Prelicensing Schools Instructor - Illinois Office Of Banks And Real Estate

APPLICATION FOR PRELICENSING SCHOOLS INSTRUCTOR

Prelicensing

Instructor

OFFICE OF BANKS AND REAL ESTATE

Code

500 East Monroe, Suite 200

112

Springfield, IL 62701

Real Estate Education Section 217/782-3338

Important Notice: Completion of this form is necessary to accomplish the requirements outlined in [225 ILCS 455/1 - 455/38.65]. Disclosure of this information is

REQUIRED. Failure to comply may result in this form not being processed. This form has been approved by the Forms Management Center.

1. Name

Last

First

Middle

2. Date of Birth

3. Social Security

_ _ /

_ _ / _ _

_ _ _ - _ _ _ - _ _ _ _

Month Date Year

4. Address ( Include Street, City, State and Zip Code)

5. Work Telephone No.

(Include area code)

( _ _ _ ) _ _ _ - _ _ _ _

6. Name and Address of School

7. School Telephone No.

(Include area code)

( _ _ _ ) _ _ _ - _ _ _ _

8. School License Number

110 -

9. List specific courses you plan to teach.

10. Personal History Information

Are you more than 30 days in arrears on any court ordered Child

YES

Support Payments?

Have you ever been convicted of a crime which you have not previously

YES

reported in writing to this office?

YES

Have you had any professional license or permit in this or any other

jurisdiction disciplined and not previously reported the action in writing

to this office?

YES

Are you in arrears on any state taxes due to the Illinois Department of

Revenue?

Are you in arrears on any Student loan acquired through the Illinois

YES

Student Assistance Commission?

IL 505-0338

Form Il 505-0338 - Application For Prelicensing Schools Instructor - Illinois Office Of Banks And Real Estate

Related Articles

Related forms

Related Categories