Fillable Background History Form (Page 3 of 3) in pdf

Background History Form Page 3

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Yes

Have you had your parole, community supervision or probation revoked:

Date of Revocation:

Explanation of circumstances leading to revocation and changes made to your sentence, if any:

Documentation Needed: Submit copies of all indictments, information, charges, judgments, orders, motions to revoke and parole,

probation/community supervision release.

8. UNLICENSED ACTIVITY

Explanation of circumstances leading to unlicensed real estate brokerage or inspector activity:

CERTIFICATION

I certify that I have personally prepared this background history form and all supporting information and

documentation, and that all such information given is true, correct, and complete. If so requested by the Texas Real

Estate Commission (the "Commission"), I will furnish all additional information or documentation as may be deemed

necessary for the verification of the information provided. I authorize and consent to the Commission's conducting

an investigation of me and the matters addressed herein as it deems necessary. I understand that information

revealed in an investigation may be cause for disapproval of my application even though other requirements for

licensing have been met.

Signature

Date

Typed or Printed Name

Position (if signing on behalf of an entity)

IMPORTANT INFORMATION - PLEASE READ THIS CAREFULLY

Please ensure the following:

a. all information is printed in ink or typewritten;

b. all requested information is provided; and

c. all questions have been answered.

IF ALL REQUIREMENTS FOR A LICENSE ARE NOT MET WITHIN ONE (1) YEAR OF THE

FILING DATE, THE APPLICATION TERMINATES.

Page 3 of 3

BH-2 (Background History Form) (06/20/2016)

Background History Form Page 3

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