Fillable CHECKLIST AND APPLICATION FOR REINSTATEMENT COMMUNITY MANAGER (Nevada Real Estate Division)

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CHECKLIST AND APPLICATION FOR REINSTATEMENT COMMUNITY MANAGER (Nevada Real Estate Division)

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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov
COMMUNITY MANAGER
CHECKLIST AND APPLICATION FOR REINSTATEMENT
The filing of this application does not authorize the applicant to conduct any activity for which a certificate is required.
APPLICATION: Attach the documents listed below and the fee of $20.00.
RENEWAL FEE: Required in addition to the reinstatement fee when a certificate has expired.
Community Association Manager Renewal Fee $200.00
Late Penalty $50.00
FINGERPRINTS: Submit the original fingerprint verification form issued by an approved fingerprint vendor.
(Obtain Form 619 for Nevada approved vendors).
NON-NEVADA RESIDENT: Out-of-state residents complete Form 656. This form is not required if completed
previously and is on file.
NON-U.S. CITIZENS: Please provide proof of eligibility to work. Copies may be enlarged.
EDUCATION: Provide certificates for 18 hours of continuing education approved by the Commission. Attach
copies of certificates meeting the education requirement. The certificates must include a minimum of 3 hours of
courses designated to fulfill Nevada community association law.
FINGERPRINT BACKGROUND WAIVER: Complete the Nevada Department of Public Safety waiver form
attached to the application.
9/20/2019 Page 1 of 4 621
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov
9/20/2019 Page 2 of 4 621
COMMUNITY MANAGER
APPLICATION FOR REINSTATEMENT
Only information deemed by law to be confidential shall be confidential (SSN, exam results, background investigation
results). Most information provided by an applicant for licensure is public information and must be provided upon
request. By policy, the Real Estate Division shall post (via the web site) and provide licensee lists which include the
licensee’s name, business address (even if same as home address), and business telephone number.
Fees are non-refundable. FEE: $20.00
Certificate Number: Date:
1. PERSONAL INFORMATION
First Name: Middle Name: Last Name:
Home Address:
City: State: Zip Code:
Mailing Address (if applicable):
City: State: Zip Code:
Phone Number: Cell Phone Number: Email Address:
2. BUSINESS INFORMATION
Business Name:
Business Address:
City: State: Zip Code:
Mailing Address (if applicable):
City: State: Zip Code:
Business Phone Number: Email Address:
DIVISION USE ONLY: Date: Receipt: Processor:
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov
9/20/2019 Page 3 of 4 621
3. BACKGROUND HISTORY
If your answer to any of the above as YES attach the order of the court or agency which was rendered as a result of the proceedings.
Give full details, including the administrative agency, court, title of the proceeding, disposition and any other pertinent information on
an attached sheet. If less than 7 years, the discharge of debtor is required for bankruptcy.
a. Have you or any business in which you are or were an owner, partner, officer or director ever been involved
in an administrative proceeding regarding any professional or occupational license?
Yes No
b. Has any license issued to you or any partnership or corporation of which you were a member or officer by
any public authority been suspended or revoked?
Yes No
c. Has an application for any type of license been denied? Yes No
d. Has a surety company declined to be surety on any bond written on you in the two years prior to the date of
the application?
Yes No
e. Have you ever filed bankruptcy or has bankruptcy been filed against you? If filed within 7 years from the
date of this application, please provide a copy of the discharge.
Yes No
Date of Discharge:
f. Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor? Yes No
g. Are you presently on parole or probation or paying any restitution? Yes No
h. Have you ever been convicted of, or are you under indictment for or have you entered a plea of guilty or nolo
contendere to forgery, embezzlement, obtaining money under false pretenses, larceny, extortion, conspiracy
to defraud or any crime involving moral turpitude?
Yes No
4. CHILD SUPPORT
PURSUANT TO NRS 645.358, THE FOLLOWING STATEMENT MUST BE ANSWERED AND SIGNED. YOUR
APPLICATION FOR THE ISSUANCE OF THIS LICENSE WILL BE DENIED IF YOU DO NOT INDICATE ON THE
STATEMENT WHICH OF THE PROVISIONS THAT APPLIES TO YOU.
I am NOT subject to a court order for the support of a child.
I am subject to a court order for the support of one or more children and AM IN COMPLIANCE with that order or plan
approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed in that
order.
I am subject to a court order for the support of one or more children and NOT IN COMPLIANCE with that order or plan
approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed in that
order.
5. SIGNATURE
• I understand that if I am subject to a court order for support of one or more children and I am not in compliance with that order
or plan, my application for license or certification or renewal of a license or certification will be denied.
• I further certify that I will faithfully comply with all the statutes and regulations of the State of Nevada pertaining to the conduct
of community managers in the State of Nevada.
• I, by signing this application, authorize any person or institution to which reference is made by me in connection with the
application to release or divulge to the Real Estate Division any information in the possession of such person or institution
regarding me.
• I hereby declare under penalty of perjury that the foregoing is true and correct.
Signature: Date:
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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 * (702) 486-4033
e-mail: realest@red.nv.gov * http://red.nv.gov
9/20/2019 Page 4 of 4 621
REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE
Pursuant to NRS 116A.435
All applicants MUST complete this section. Please select ONE option.
I have a Nevada business license number assigned by the Nevada Secretary of State upon compliance with the
provisions of NRS Chapter 76.
My Nevada business license number is:
I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with the
provision of NRS Chapter 76 and my application is pending.
I do NOT have a Nevada business license number.
The Real Estate Division is not the arbiter of determining whether the applicant needs a business license. Information
about the Nevada business license can be found on the Secretary of State’s website at: http://nvsos.gov/.
0505RCCD-003(07/2017rev)
Fingerprint Background Waiver Page 1 of 2
Fingerprint Background Waiver
As an applicant who is the subject of a Federal Bureau of Investigation (FBI) fingerprint-based
criminal history record check for a noncriminal justice purpose you have certain rights which are
discussed below.
1. You must be notified by the Nevada Real Estate Division (name of requesting agency)
that your fingerprints will be used to check the criminal history records of the FBI and the
State of Nevada.
2. If you have a criminal history record, the officials making a determination of your suitability
for the job, license or other benefit for which you are applying must provide you the
opportunity to complete or challenge the accuracy of the information in the record. You may
review and challenge the accuracy of any and all criminal history records which are returned
to the submitting agency. The proper forms and procedures will be furnished to you by the
Nevada Department of Public Safety, Records Bureau upon request. If you decide to challenge
the accuracy or completeness of you FBI criminal history record, Title 28 of the Code of
Federal Regulations Section 16.34 provides for the proper procedure to do so:
16.34 - Procedure to obtain change, correction or updating of identification
records. If, after reviewing his/her identification record, the subject thereof
believes that it is incorrect or incomplete in any respect and wishes changes,
corrections or updating of the alleged deficiency, he/she should make application
directly to the agency which contributed the questioned information. The subject of
a record may also direct his/her challenge as to the accuracy or completeness of any
entry on his/her record to the FBI, Criminal Justice Information Services (CJIS)
Division ATTN: SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306.
The FBI will then forward the challenge to the agency which submitted the data
requesting that agency to verify or correct the challenged entry. Upon the receipt of
an official communication directly from the agency which contributed the original
information, the FBI CJIS Division will make any changes necessary in accordance
with the information supplied by that agency.
3. Based on 28 CFR § 50.12 (b), officials making such determinations should not deny the
license or employment based on information in the record until the applicant has been
afforded a reasonable time to correct or complete the record or has declined to do so.
4. You have the right to expect that officials receiving the results of the fingerprint-based
criminal history record check will use it only for authorized purposes and will not retain or
disseminate it in violation of federal or state statute, regulation or executive order, or rule,
procedure or standard established by the National Crime Prevention and Privacy Compact
Council.
0505RCCD-003(07/2017rev)
Fingerprint Background Waiver Page 2 of 2
5. I hereby authorize the Nevada Real Estate Division (name of requesting agency)
(name of requesting agency), to submit a set of my fingerprints to the Nevada Department
Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada
and FBI criminal history records that may pertain to me.
In giving this authorization, I expressly understand that the records may include information
pertaining to notations of arrest, detainments, indictments, information or other charges for
which the final court disposition is pending or is unknown to the above referenced agency.
For records containing final court disposition information, I understand that the release may
include information pertaining to dismissals, acquittals, convictions, sentences, correctional
supervision information and information concerning the status of my parole or probation
when applicable.
6. I hereby release from liability and promise to hold harmless under any and all causes of legal
action, the State of Nevada, its officer(s), agent(s) and/or employee(s) who conducted my
criminal history records search and provided information to the submitting agency for any
statement(s), omission(s), or infringement(s) upon my current legal rights. I further release
and promise to hold harmless and covenant not to sue any persons, firms, institutions or
agencies providing such information to the State of Nevada on the basis of their disclosures. I
have signed this release voluntarily and of my own free will.
A reproduction of this authorization for release of information by photocopy, facsimile or similar
process, shall for all purposes be as valid as the original.
In consideration for processing my application I, the undersigned, whose name and signature
voluntarily appears below; do hereby and irrevocably agree to the above.
Applicant’s Name:
PLEASE PRINT
Last Name
First Name
ADDRESS:
PLEASE PRINT
Applicant’s Signature:
Date:
Submitting Agency:
Nevada Real Estate Division
Address:
3300 West Sahara Avenue #350
Las Vegas, NV 89102
Agency Representative:
PLEASE PRINT
Last Name
First Name
Agency Representative Signature:
Date:
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CHECKLIST AND APPLICATION FOR REINSTATEMENT COMMUNITY MANAGER (Nevada Real Estate Division)

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Completed 28 December 2021

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