ARKANSAS REAL ESTATE COMMISSION
Phone: (501) 683-8010 Fax: (501) 683-8020
REAL ESTATE PRINCIPAL INSTRUCTOR
APPLICATION
AREC 3/2014
Instructions: is application must be completed, signed and notarized. Each question must be answered
and the necessary documentation and fees attached or the application will be returned to the applicant.
Have you ever been convicted of or plead guilty or nolo contendere to any crime other than a trac viola-
tion? _____YES _____ NO Being convicted shall include all instances in which a plea of guilty or nolo con-
tendere or nding of guilt is the basis for the conviction, and all proceedings in which the sentence has been
deferred or suspended. (If responded Yes, provide a written report of the conviction which should include
the date of the oense and of the conviction, the name and address of the court, the specic crime of which
convicted or to which a guilty plea or nolo contendere [no contest] was entered, the ne, penalty and/or other
sanctions imposed, and copies of the charging document and judgement of conviction or other disposition
including probation or suspension of sentence. All requested documents and reports must be included with
the application.)
Applicant’s Name: _____________________________________________________________________
(First Name) (Middle Name) (Last Name)
Home Address: ____________________________________________ PO Box: ____________
Gender: ___________________________
Personal Phone: ________________________ Email Address: _________________________________
Highest level of education completed: ______________________ Completion date: ________________
Name and location of school: ____________________________________________________________
City: __________________________________ State: __________ Zip: _____________
Real Estate License Number: _________________________ Status: Active Inactive Expired
Real Estate Firm: _______________________________________ Firm Phone: ___________________
License Issuance Date: _______________________ License Expiration Date: ____________________
Firm Address: ____________________________________________ PO Box: ____________
City: __________________________________ State: __________ Zip: _____________
PART I - PERSONAL INFORMATION
PART II - REAL ESTATE FIRM INFORMATION
Return to: Arkansas Real Estate Commission | 612 South Summit St | Little Rock, AR 72201
COMMISSION USE ONLY
Receipt # ______________
Date Paid ______________
