Application For License For Real Estate Salesman Form 2000

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WREC 03/00
Office Use Only
Lic. No. _______________________
WYOMING REAL ESTATE COMMISSION
Issued _________________________
2020 CAREY AVE., STE 100
CHEYENNE WY 82002
APPLICATION FOR LICENSE FOR REAL ESTATE SALESMAN
In compliance with the Wyoming Real Estate License Act of 1971, I hereby make application for authorizing me to
engage in the business of REAL ESTATE SALESMAN, and in support of this application make the following statements
under oath:
[ ] Mr. [ ]Mrs. [ ] Miss
[ ]Resident
[ ]Non Resident
[ ]Reciprocal
1.
Name____________________________________________________________________________________________
Last (Please print or type)
First
Initial
2.
Date of Birth__________________Place of Birth___________________Social Security_____________________
3.
Residence Address___________________________________________________________________________
Street
City
State
Zip
4.
Business Phone______________FAX______________E-Mail________________Home Phone______________
5.
Do you understand that making a false representation in an application shall be
cause for the Commission to take disciplinary action, including suspension or
revocation against such licensee pursuant to the License law, Wyoming Statutes 33-
______________
28-111?
Yes or No
6.
Have you ever had an application as a Real Estate Salesman or Broker rejected in
______________
W y o m i n g
o r
i n
a n y
o t h e r
s t a t e ?
I f
y e s ,
s u b m i t
Yes or No
explanation._______________________
_______________
7.
Has any surety company ever declined to be a surety on your bond, or revoked a
Yes or No
b
o
n
d
?
I
f
y
e
s
,
s
u
b
m
i
t
explanation._______________________________________________
8.
Have you ever been convicted or pleaded nolo contendere to a felony or are such
_______________
Yes or No
charges pending at this time? If yes, give nature of each arrest or complaint, date,
name and location of court, and disposition of each incident. If now on parole or
p
r
o
b
a
t
i
o
n
,
s
o
state.____________________________________________________________
9.
List all professional licenses (real estate, appraiser, architect, pharmacist, CPA, etc.) that you presently hold or
previously have held in Wyoming or any other state. If none, state “None.”
License _____________ State ______________ Dates: From ________________ To ________________
License _____________ State ______________ Dates: From ________________ To ________________
License _____________ State ______________ Dates: From ________________ To ________________
Note: (1) Fill out carefully. Each question must be answered or the application will be returned to the applicant.
This application must be filed within 60 days of the notice date that informed the applicant of a passing score.
(2) The following must accompany this application:
a. Required original license fee. $75.00
b. Fingerprint card. (All spaces requiring personal data are to be filled in by the applicants.) Prints should be
taken by local authorities in the county and/or city where applicant lives. (Not available on website)
c. Recent photograph.
d. Certificates for Salesman Course I and Salesman Course II.
e. Non-Resident applicants-Agreement and Service of Process

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