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CRIMINAL HISTORY FOR PRE-DETERMINATION INSTRUCTIONS FOR THE PETITION (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/
INSTRUCTIONS FOR THE PETITION TO REVIEW
CRIMINAL HISTORY FOR PRE-DETERMINATION
Pursuant to NRS 622, a person with a criminal history may petition the Nevada Real Estate Division to review
his or her criminal history to determine if the person’s criminal history will disqualify that person from
obtaining a license, certificate, permit or registration from the Division.
Instructions:
1. Complete the Petition to Review Criminal History for Pre-Determination, Real Estate form 550, and the
Nevada Department of Public Safety Fingerprint Background Waiver.
2. Review the Authorized Fingerprinting Vendor form, 619, and find a vendor to submit your fingerprints
electronically. The authorized vendor will provide you with a Verification of Fingerprints Submitted
form after your fingerprints have been submitted through LiveScan.
3. Submit the following to the Nevada Real Estate Division:
➢ Completed Petition to Review Criminal History for Pre-Determination (form 550)
➢ Completed Nevada Department of Public Safety Fingerprint Background Waiver
➢ Completed Verification of Fingerprints Submitted form
➢ Non-refundable fee of $50.00 which may be paid by cash (exact change), credit card or check
made payable to the Nevada Real Estate Division.
4. Criminal background results are good for six months from the date received by the Nevada Real Estate
Division.
5. The Nevada Real Estate Division will make a pre-determination 30 days after the receipt of criminal
background history from the Nevada Department of Public Safety. The petitioner will be notified by mail
of whether the petitioner’s criminal history will qualify or disqualify them from obtaining a license,
certificate, permit or registration.
6. The Nevada Real Estate Division is not bound by its determination and may rescind such determination
at any time.
9/12/2019 Form 550
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/
9/12/2019 Form 550
REAL ESTATE DIVISION USE ONLY – DO NOT WRITE IN THIS BOX
Date Petition Received: Division Staff Initials:
Date Results Received from DPS:
Qualified Disqualified Date Determination Made: Division Staff Initials:
PETITION TO REVIEW CRIMINAL HISTORY FOR
PRE-DETERMINATION PURSUANT TO NRS 622
Fee (Non-Refundable): $50.00
First Name: Last Name:
Last Four Digits of Social Security Number (SSN): Date of Birth:
Mailing Address:
Street Number and Name City State Zip Code
Email Address: Contact Telephone Number:
I am petitioning the Real Estate Division to review my criminal history to determine if my criminal history will
disqualify me from obtaining a license, certificate, permit or registration from the Real Estate Division. I
understand that pursuant to NRS 622, the Real Estate Division is not bound by its determination of
disqualification or qualification and may rescind such a determination at any time. I understand that I am
required to utilize an authorized fingerprint vendor listed on Real Estate Division form 619 and that I am
responsible for any fees charged by the vendor that I choose.
Signature: Date:
click to sign
signature
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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
Middle
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
Middle
Date:
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CRIMINAL HISTORY FOR PRE-DETERMINATION INSTRUCTIONS FOR THE PETITION (Nevada Real Estate Division)

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Completed 28 December 2021

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