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

Form Il 505-0339 - Real Estatae Continuing Education Instructor - Illinois Office Of Banks And Real Estate

REAL ESTATAE CONTINUING EDUCATION INSTRUCTOR

CODE 163

Important Notice: Completion of this form is necessary to

OFFICE OF BANKS AND REAL ESTATE

accomplish the requirements outlined in The Real Estate

500 East Monroe, Suite 200

License Act of 2000.

Disclosure of this information is

Springfield, IL 62701

REQUIRED. Failure to comply may result in this form not

being processed. This form has been approved by the Forms

REAL ESTATE EDUCATION 217/ 782-3338

Management Center.

3. Social Security Number.

1. Name

Last

First

Middle

2. Date of Birth

_ _ / _ _ / _ _

_ _ _ - _ _ - _ _ _ _

Month Date Year

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

5. Work Telephone Number

(Include Area Code)

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

6. Are you and an approved Real Estate Prelicensing course instructor in Illinois or another

7. Home Telephone Number

(Include Area Code)

1 1

jurisdiction?

Yes

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

If “Yes” Certificate/License No.:

8. List courses you plan to teach -- approval of this instructor application does not guarantee approval of any specific course. All

courses must be approved separately under submission to the Office of Banks and Real Estate by an approved continuing education

sponsor.

9. Personal History Information

1 1 YES

q q NO

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

Payments?

q q YES

w w NO

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

writing to this office?

q q YES

w w NO

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?

q q YES

w w NO

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

q q YES

w w NO

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

Assistance Commission?

IL 505-0339

rev(1)1097

Form Il 505-0339 - Real Estatae Continuing Education Instructor - Illinois Office Of Banks And Real Estate

Related Articles

Related forms

Related Categories