Application For License For Real Estate Salesman Form 2000 Page 2

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f. If licensed in another state, current and/or expired, certification of license history is required.
g. Proof of legal presence. (See attached List A and List B).
10.
Have any of the professional licenses (in question #9) ever been disciplined, suspended, revoked, or are such
charges pending at this time? ________
If yes, submit explanation.
11.
Give 3 character references other than relatives who will vouch for your honesty, trustworthiness and reputation
for fair dealings: (Include at least one business or professional person by whom you have not been employed
or associated.)
________________________________________________________________________________________________
Name-Please Print
Occupation
Street address
City
State
___________________________________________________________________________________________________
Name-Please Print
Occupation
Street address
City
State
_____________________________________________________________________________________________________
Name-Please Print
Occupation
Street address
City
State
12.
EDUCATION: (Circle only the last year which you fully completed in each education level.)
HIGH SCHOOL
9 10 11 12 GED
Did you graduate? _____________________
COLLEGE
13 14 15 16 17 18 19
Degrees _______________________________
Other____________________________________________________________________________________________
13.
EMPLOYMENT HISTORY: Give a complete work history, including part-time work if any, for the past 5 years
starting with your most recent or present position and work back. (Attach separate sheet if necessary.)
____________________________________________________________________________________________________________________________
Employer
Address
___________________________________________________________________________________________________________________________
Your title
Name of supervisor
From
To
___________________________________________________________________________________________________________________________
Reason for leaving
_______________________________________________________________________________________________________________________________
Employer
Address
___________________________________________________________________________________________________________________________
Your title
Name of supervisor
From
To
___________________________________________________________________________________________________________________________
Reason for leaving
___________________________________________________________________________________________________________________________
Employer
Address
___________________________________________________________________________________________________________________________
Your title
Name of supervisor
From
To
___________________________________________________________________________________________________________________________

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