Fillable Initial Real Estate Salesperson License Application Part A (Louisiana Real Estate Commission)

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Initial Real Estate Salesperson License Application Part A (Louisiana Real Estate Commission)

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Louisiana Real Estate Commission (LREC) aim to regulate real estate affairs in the state of Louisiana. LREC help protect the public interest during activites including real estate transactions.

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LOUISIANA REAL ESTATE COMMISSION
9071 Interline Avenue
Baton Rouge, LA 70809
(225) 925-1923 or (800) 821-4529 (LA only)
Initial Real Estate Salesperson License Application – Part A
Complete this form to apply for an initial Resident, Non-Resident, or Reciprocal Real Estate Salesperson License.
Read the instructions carefully, as certain application requirements may differ for each license type. Personal
checks, company checks, cashier’s checks, and money orders are accepted. Make fees payable to the Louisiana
Real Estate Commission. Please do not send cash through the mail.
Initial license fee……………………………... $45.00
Research and Education Fund fee………… $10.00
Recovery Fund fee…………………….......... $10.00
Application Processing fee…………………. $25.00
TOTAL....................................................... $90.00
Errors and Omissions Insurance premiums that may be due upon submission of this application are not included in the total amount
listed.
TYPE OF LICENSE FOR WHICH YOU ARE APPLYING: Select one
Louisiana Resident
Reciprocal Non-resident (Active resident licensee in AL, AR, CO, GA, IA, MS, NM, OK,
or
PA)
Non-resident (Active resident licensee in a state other than Louisiana or the above reciprocal states)
PERSONAL INFORMATION: Complete all applicable sections
1. Legal first name and middle initial __________________________________________________
2. Legal last name (and suffix, if any) __________________________________________________
Licensees are restricted from advertising in any name other than the identical name that appears on their license. If
you are known by a name other than the legal name listed above, such as a nickname or your middle name, and you
wish to be licensed in that name, you must indicate the specific name, including any suffix, as you wish for it to
appear on your license and in all advertising. (Ex:
First Middle “Nickname” Last
or
“Nickname” Last
or
First, Middle,
Last, Jr. or other variations of your choice
)
3. State your name exactly as you wish for it to appear on your license:
___________________________________________________________________________________________
In accordance with LA R.S. 37:23, you are required to provide your social security number on all applications for a
state license or certificate. The law charges the LREC with the responsibility for maintaining the confidentiality of this
information. The LREC is prohibited from releasing any social security number, unless requested to disclose it to the
agency charged with implementing a program of family support, as specified in LA R.S. 46:236.1.1 et seq.
4. Enter your social security number here
A United States Permanent Resident Card (Form I-551), commonly known as an Alien Registration Card or Green
Card, is issued as proof of a non-citizen’s lawful permanent resident status in the United States. An individual with a
valid Form I-551 has the right to live and work permanently in the United States. If you are a permanent resident age
18 or older, you are required to have a valid green card in your possession at all times. See Immigration and
Nationality Act, INA: Act 264 – Forms and Procedures [8 U.S.C. 1304]. Skip No. 5 if it is not applicable to you.
5. Enter your alien registration number here
InitSales Rev. 07/2020
Page 1 of 3
FOR LREC USE ONLY
Clear Form
Initial Real Estate Salesperson License Application – Part A – Page 2 of 3
6. Date of birth (mm/dd/yyyy) and gender _____/_____/________ Male Female
PREFERRED MAILING ADDRESS AND DAYTIME TELEPHONE NUMBER:
7. Street number or P.O. Box _______ ____________________________________
City, State, Zip+4 _______ ____________________________________
Parish/County ___________________________________________
8. Daytime phone number ( ) ___ ___ ___ - ___ ___ ___ ___
HOME ADDRESS AND TELEPHONE NUMBER: (USE PHYSICAL ADDRESS ONLY)
9. Street number _______ ____________________________________
City, State, Zip+4 _______ ____________________________________
Parish/County ___________________________________________
10. Home phone number ( ) ___ ___ ___ - ___ ___ ___ ___
11. How long have you lived in your current state? _____________ days months years
OTHER CONTACT INFORMATION
12. Cell phone number
13. E-mail address
( ) ___ ___ ___ - ___ ___ ___ ___
_______________________________________________________________________
15. If yes, list each name, date, and state in
which a real estate
license has ever been issued to you. Use
an attachment if necessary. You must attach
official license history verifications from each state that has
issued you a real estate
license.
(a
) __________________________________________________________________________________________
(b) __________________________________________________________________________________________
(c) __________________________________________________________________________________________
InitSales Rev. 07/2020
14. Are you currently licensed, or have you ever been licensed, as a real estate salesperson or broker in
Louisiana or any other state? Yes No
16. Have you ever had a salesperson or broker license denied, censured, suspended, or revoked in
Louisiana or any other state? If yes, furnish a letter of detail with this application.
Yes
No
17. Have you ever been convicted, pled guilty or nolo contendere to (a) the crimes of forgery,
embezzlement, obtaining money under false pretenses, larceny, extortion, conspiracy to defraud, theft, or
any crime of moral turpitude, or (b) any felony crime in a court of competent jurisdiction?
Page 2 of 3
Yes No (If yes, furnish a letter of detail with this application.)
Applicant's Full Name: __________________________________________
18. All applicants are required to provide proof of completion of the 90-hour prerequisite course
work required for this license. Attach a copy of the 90-hour prerequisite course work certificate.
19. Name the institution and the city and state from which your high school diploma or
equivalency certificate was received:
Name: __________________________________________________________________________________
Location: _________________________________________________________________________________
EDUCATION: (not applicable to reciprocal applicants)
Initial Real Estate Salesperson License Application – Part A – Page 3 of 3
IRREVOCABLE CONSENT TO SERVICE OF PROCESS AND POWER OF ATTORNEY FOR
RECIPROCAL AND NON-RESIDENT APPLICANTS ONLY: I do hereby irrevocably make, constitute,
and appoint the Executive Director of the Louisiana Real Estate Commission, and any successors
in office, my true and lawful attorney-in-fact, and in the State of Louisiana, upon whom all process of
law concerning me in any legal action or proceeding may be served, subject to and in accordance
with all laws of the State of Louisiana and all amendments thereto, and I do hereby specifically agree that
in any and all such legal processes of law, which may be served upon my attorney-in-fact, shall be
deemed served upon me personally, and that all such processes of law served upon my attorney-in-fact
shall have the same effect as if I were a resident of the State of Louisiana and have been personally
served with such process of law.
CERTIFICATION AND ACKNOWLEDGMENT FOR ALL APPLICANTS: I attest that I have knowledge of
and understand the provisions of the Fair Housing Act of 1968, the Louisiana Equal Housing Opportunity
Act, and any amendments thereto, and that I will neither induce nor attempt to induce any person to sell or
rent any dwelling by representation regarding the entry or prospective entry into an area, subdivision or
neighborhood of a person or persons of a particular race, color, religion or national origin. I
hereby acknowledge the forfeiture of all fees filed with my application for a Louisiana real
estate license in the event that I do not obtain the license for which I have applied. Further, if this
application is acted upon favorably, I agree to comply with all the laws embodied in Title 37,
Chapter 17, Louisiana Revised Statutes of 1950, and amendatory acts, and the Rules and
Regulations of the Louisiana Real Estate Commission. I hereby certify that all the information
provided herein is true and correct and the Louisiana Real Estate Commission may rely on its
truthfulness in considering this application.
______________________________________________
____________________
Signature of Applicant Date
received and accepted. Background reports expire in 120 days, so make sure to time your submission as
close as possible to taking the exam. The following is an important part of the application process.
Please proceed with care. IMPORTANT: If you do not have a sponsoring broker at the time of
application for testing, only Part A-Initial Real Estate Salesperson License Application should be
submitted. Upon passage of the examination, you will have 90 days to secure a sponsoring broker
and submit Part B-Initial Real Estate Salesperson Sponsorship Affidavit to complete the licensing
process. Upon passage of the examination, but prior to the issuance of a license, you must show proof
of Errors and Omissions insurance coverage. A license will not be issued until such proof is provided.
Please notify the LREC of any disability which may require special accommodations, auxiliary aids, or
services, with regard to the application process.
InitSales Rev. 12.2017
CRIMINAL BACKGROUND:
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9LVLW https://lrec.gov/become-licensed/salesperson/background-check/ to begin the process for
ordering your criminal background check. There you will find complete instructions for setting up
a user account and ordering your criminal background check.
InitSales Rev. 07/2020
Page 3 of 3
Applicant's Full Name: __________________________________________
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Initial Real Estate Salesperson License Application Part A (Louisiana Real Estate Commission)

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