229 Peachtree Street NE
Atlanta, GA 30303-1605
Phone: 404-656-3916
Fax: 404-656-6650
Suite 1000 - International Tower
GREC Reinstatement Fees (11-2014)
Page 3 of 3
Georgia Real Estate Commission
Georgia Real Estate Appraisers Board
Email: grecmail@grec.state.ga.us
Background Information
Section D
(1) In Georgia, or any other state, jurisdiction, or country, have you 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)
YES NO
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)
Have you ever been disciplined by the Georgia Real Estate Commission or the Georgia Real Estate Appraisers Board?
(3) Have you 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.)
If you answered "YES" to question (3), you must include the following documents with this application, UNLESS you have
already submitted them to this agency:
(A) For every occurrence, provide a certified copy of the final order from the licensing agency that imposed the disciplinary action.
(B) Provide a detailed written statement that includes:
1) an explanation of the circumstances surrounding the disciplinary action
2) whether you have made any required payment
3) whether you have completed all conditions of your disciplinary action
4) whether your license is currently suspended or revoked
YES NO
YES NO
Date:
Applicant Signature:
I hereby authorize a representative of the Georgia Real Estate Commission and Appraisers Board to periodically obtain and receive
any criminal history record information on me which may be in the files of any federal, state, or local criminal justice agency.
I understand that after a review of this application and accompanying documents, the Georgia Real Estate Commission and
Appraisers Board may require me to provide additional information in order to process the application.
I hereby certify the information provided in this application is true and correct to the best of my knowledge and belief.
Certification
Section E
