Fillable REAL ESTATE DIVISION TIMESHARE LICENSE CHECKLIST AND APPLICATION (Nevada Real Estate Division)

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REAL ESTATE DIVISION TIMESHARE LICENSE CHECKLIST AND APPLICATION (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
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 1 of 7 Form 519
TIMESHARE LICENSE
CHECKLIST AND APPLICATION
The filing of this application does not authorize the applicant to conduct any activity for which a license is
required. Involvement in any such activity before any license is issued maybe grounds for denial of the license,
subsequent suspension, or revocation of a license.
Prior to submitting this application, be sure each question has been completely, thoroughly, and honestly
answered. This application must be signed and notarized, contain all supporting documentation, and payment for
the fee. Fees are non-refundable.
APPLICATION and FEES: Residents and non-residents 18 years or older, may apply with a complete
application form 519.
FINGERPRINTS: Attach verification of prints taken electronically by an approved vendor. The approved
vendor list is located on the NRED website, see Form 619.
EDUCATION: Provide a copy of the 14-hour timeshare course certificate issued by an approved provider. A list
of providers is available on the Division’s website under forms (Form 502).
EXAM: For exam scheduling, contact Pearson VUE testing service: http://www.pearsonvue.com/nv/realestate/,
or call: (888) 248-8055.
FEE: $200.00 license fee.
BACKGROUND INVESTIGATION REPORT: Attach a copy of the background investigative report
performed by the timeshare project, project broker, broker, Developer, or resale company.
FINGERPRINT BACKGROUND WAIVER: Complete the Nevada Department of Public Safety waiver form
attached to the application.
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 2 of 7 Form 519
ORIGINAL TIMESHARE SALES AGENT APPLICATION
(NRS 119A.210)
Fee: $200.00
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 sell licensee lists which include the
licensee’s name, business address (even if same as home address), and business telephone number.
PROVISIONAL LICENSE NUMBER: FULL LICENSE NUMBER:
1. FULL NAME:
Date of Birth: Last 4 of Social Security Number or Individual Taxpayer ID:
Legal Residence Address:
City: State: Zip Code:
Mailing Address:
City: State: Zip Code:
Email Address: Home Phone:
2. OTHER NAMES:
Have you ever used any other name(s) other than the one given above? Yes No
If yes, provide name(s):
Maiden: Married: Other:
3. OCCUPATIONS: List names and addresses of your past three (3) years of employment including your present
employer, stating each kind and nature of business, vocation, or employment in which you were engaged. To account
for any lapse in employment indicate either retired, school, housewife, etc.
a. Employer Name or Unemployed:
Occupation: From to
Address (City, State):
b. Employer Name or Unemployed:
Occupation: From to
Address (City, State):
c. Employer Name or Unemployed:
Occupation: From to
Address (City, State):
Division Only
Receipt Number: Date: Initials:
FP Sent Date: Received Date – FBI: State:
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 3 of 7 Form 519
4. RESIDENCES: List all addresses where you have resided for the past three (3) years, accounting for the entire
period. Set forth the exact period of time, giving month, day and year that you resided at each address. If additional
spaces are needed, attach a typewritten or printed schedule
a. Number and Street:
City: State: Zip Code:
From to
b. Number and Street:
City: State: Zip Code:
From to
c. Number and Street:
City: State: Zip Code:
From to
5. OTHER LICENSES: Have you ever been issued any type of license, certification, or permit including Real Estate
and/or Time Share, by a state agency or public authority in Nevada or any other state? Yes No
If yes, supply the following information:
a. License Number: Type: Issue Date: Expiration Date:
b. License Number: Type: Issue Date: Expiration Date:
6. CRIMINAL HISTORY AND OTHER INFORMATION: If your answer to any of the questions listed below is
YES, please attach the order of the court or agency which was rendered as a result of the proceedings. Provide full
details, including the administrative agency, court, title of the proceeding, disposition and any other pertinent
information on an attached sheet.
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 denied, suspended or revoked?
Yes No
c. Has a surety company declined to be surety on any bond written on you in the two years prior to the date
of this application?
Yes No
d. Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor? Yes No
e. 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
f. Are you presently on parole or probation or paying any restitution? Yes No
g. 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.
Date of discharge:
Yes No
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 4 of 7 Form 519
7. CHILD SUPPORT: PURSUANT TO NRS 119A.263, your application for the issuance of this license will be
denied if you do not indicate which of the provisions apply 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.
8. DECLARATION: Signature of applicant (NRS 53.045)
I, (print name) , hereby, under penalty of perjury, declare that the
answers contained in this application are true and correct; and 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, certification or renewal of a license or certification will be denied;
• That I will faithfully comply with all the statutes and regulations of the State of Nevada pertaining to the
conduct of real estate licensees in the State of Nevada;
• That by signing this application I 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.
Signature of Applicant: Date:
(Leave Section 8 blank for applicants affiliating with a timeshare resale company.)
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 5 of 7 Form 519
Nevada Real Estate Division
DEVELOPER AFFIDAVIT
9. I, , an officer of the developer, hereby certify that, (print the name of the
applicant) , there herein named Time Share Sales Agent applicant, has completed
the required 14 hours of instruction in ethics, the applicable laws and regulations relating to time shares, principles
and practices of selling Time-shares, and NRS and NAC 119A. Further, that he/she bears a good reputation for
honesty, trustworthiness and competency, and I hereby recommend that a license be granted to the applicant.
Timeshare Project Company Name
Address (Location where applicant will conduct business)
City State Zip Code
Mailing Address (if applicable)
City State Zip Code
Developer Company Name
Broker’s Real Estate Company Name Broker’s Real Estate License Number
Name of Licensed Real Estate Broker (Print) Notarized Signature of Real Estate Broker
State of
County of
This instrument was acknowledged before me on (date) by (print name of person signing this
document) .
Seal
Signature of Notary
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 6 of 7 Form 519
10. The Real Estate or Project Broker (Broker) of record for the Company:
Address/Location:
Timeshare project or timeshare resale company hereby acknowledges that he/she personally knows the applicant,
(print name of Applicant) , and that the Broker has reviewed all of
the information on the timeshare agent application, with the applicant, and that to the best of his/her knowledge the
applicant has not made any false statements of material fact or any omissions of material fact. Broker further
acknowledges that if applicant has made any material misrepresentation or omission in the foregoing application,
applicant’s license issued pursuant to the referenced application will be invalidated. Specifically, broker
acknowledges that:
(1) a report on the background of the applicant has been obtained from a licensed private investigator or other
reputable source acceptable to the Division;
(2) he/she is satisfied that the applicant has a reputation for honesty, trustworthiness and competence; and
(3) that, there is a written agreement between the broker and the applicant in which applicant states the he
understands and agrees that his employment in a position as a provisional sales agent will be terminated if the
Division denies his application. Broker acknowledges that a FBI background investigation will be conducted by
the Division.
Signature of Broker:
State of
County of
This instrument was acknowledged before me on (date) by (print name of person signing this
document) .
Seal
Signature of Notary
STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102 / (702) 486-4033
realest@red.nv.gov / http://red.nv.gov/
Revised 12/18/2019 Page 7 of 7 Form 519
REPORT OF EXISTENCE OF NEVADA BUSINESS LICENSE
Pursuant to NRS 353C.1965
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/.
ARE YOU A VETERAN? Yes No
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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REAL ESTATE DIVISION TIMESHARE LICENSE CHECKLIST AND APPLICATION (Nevada Real Estate Division)

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