229 Peachtree Street NE
Atlanta, GA 30303-1605
Phone: 404-656-3916
Fax: 404-656-6650
Suite 1000 - International Tower
GREAB OPEN A SCHOOL (12-2014)
Page 2 of 4
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
(1) In Georgia, or any other state, jurisdiction, or country, has the School, any owner, officer or stockholder, or the School Director or
Coordinator ever been convicted of, pled nolo contendere to, or been granted first offender treatment upon being charged with (1) a criminal
offense other than a traffic violation or (2) driving under the influence (DUI) of alcohol or drugs?
You must answer YES to this question even if:
(a) you have been pardoned for the criminal offense;
(b) anyone (lawyer, teacher, broker, government official, etc.) has told you that: (1) the offense is not, or is no longer 'on record', (2) the
offense has been expunged from your record, or (3) you do not have to disclose the offense, (4) your civil and political rights have
been restored, or (5) any similar statement that appears to suggest your 'record' has been cleared; or
(c) the conviction is not reported by the Georgia Crime Information Center (GCIC) or the National Crime Information Center (NCIC).
If YES, you must include the following documents with this application, UNLESS you have already submitted
them to this agency:
(A) For every occurrence (with the exception of a single DUI), provide a certified copy of the citation, accusation, or indictment
that led to the conviction AND a certified copy of the sentence / final disposition. If the court disposition is unavailable, provide a
letter from the court stating the documents are not available.
(B) For every occurrence (including that of a single DUI) provide a detailed written statement that includes:
1) an explanation of the circumstances surrounding every conviction
2) whether you have made any required restitution
3) whether you have completed all conditions of your sentence
4) whether you are on parole or probation (and the date it will end)
School Personnel
Section B
Director:
Birth date
(mm/dd/yyyy)
SSN:
Birth date
(mm/dd/yyyy)
SSN:
Coordinator:
NOTIFICATION OF REQUEST FOR SOCIAL SECURITY ACCOUNT NUMBER (SSAN)
The Georgia Real Estate Appraisers Board will not release your SSAN to any third party except as required by law.
Background Information
Section C
Contact Person:
Phone:
Phone:
Phone:
E-MAIL:
E-MAIL:
E-MAIL:
NO YES
Failure to disclose any conviction, nolo contendere plea, or first offender sentence to a criminal offense, is grounds for denial of
your license. Additional information about the Background Clearance is located on the website at www.grec.state.ga.us.
(2) Has the School, any owner, officer or stockholder, or the School Director or Coordinator ever been disciplined by the Georgia Real Estate
Commission or the Georgia Real Estate Appraisers Board?
(3) Has the School, any owner, officer or stockholder, or the School Director or Coordinator ever been disciplined by any other state or
federal licensing agency or authority which regulates any profession? (Disciplinary actions include, but are not limited to, such actions as: a
reprimand, a suspension, a revocation, a fine, or any restriction placed on a license.)
NO
YES
NO YES