Form Mcd-1 - Moral Character Determination Page 2
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1
210. (a)
Have you ever had a professional or occupational license in this state or any other state placed on
No
Yes
probation, suspended, cancelled or revoked, or ever surrendered such a license?
(b)
Have you ever had an application for a professsional or occupational license disapproved or denied in this
state or any other state?
Yes
No
(c)
Are there any disciplinary hearings or investigations pending against any professional or occupational
Yes
No
licenses you hold in this state or any other state?
If the answer to (a), (b), or (c) is YES, you must complete the applicable sections of the Background History Form located at http://
Yes
No
11. Are there any unpaid judgments against you?
If the answer is YES, you must complete the applicable sections of the Background History Form located at
pdf/forms/miscellaneous/BackgroundHistory.pdf.
12.
(a)
Have you ever been convicted of a criminal offense? Include all felonies and misdemeanors other than
minor traffic tickets.
Yes
No
(b)
Have you ever been placed on parole, probation, or community supervision (also known as deferred
adjudication) regardless of whether the case was dismissed or you were discharged?
Yes
No
(c)
Are there any criminal charges pending against you?
Yes
No
If the answer to (a), (b), or (c) is YES, you must complete the applicable sections of the Background History Form located at http://
13.
Have you ever acted or attempted to act, as a real estate broker, sales agent, inspector or appraiser in this
Yes
No
state or any other state at a time when not properly licensed? (Include all periods in which you acted either
before obtaining a license or after a license may have expired.)
If the answer is YES, you must complete the applicable sections of the Background History Form located at
pdf/forms/miscellaneous/BackgroundHistory.pdf.
14.
List below all names (maiden, aliases, nicknames, etc) by which you have been known.
CERTIFICATION OF APPLICANT
I certify that I examined this MCD form and the answers given are true, correct, and complete. I authorize the Texas Real Estate
Commission to conduct any investigations of me that it considers prudent. I further understand that information submitted in
conjunction with this form may become a public record. I request the Texas Real Estate Commission to determine if my moral
character (based on what I submit) complies with the requirements for licensing under Section 1101.353 or 1102.106, Texas
Occupations Code.
Signature
Date Signed
PRIVACY NOTICE
In accordance with Chapter 559, Government code, the following notice about certain information laws and practices is given.
(1)
With few exceptions, an individual is entitled on request to be informed about the information that a state governmental body collects
about the individual.
(2)
Under Sections 552.021 and 552.023 of the Government Code, the individual is entitled to receive and review the information.
Under Section 559.004 of the Government Code, the individual is entitled to have the governmental body correct information about the
(3)
individual that is incorrect.
MCD-1 (Moral Character Determination Form) (Revised 07-01-2016)
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