NEBRASKA REAL ESTATE COMMISSION

NEBRASKA REAL ESTATE COMMISSION
REAL ESTATE RE-INSTATEMENT APPLICATION
EXAMINATION FEE: $115.00

For Commission Use Only ____________________
Receipt# ____________________

FEES ARE NOT REFUNDABLE
Sample Copy

INSTRUCTIONS:

1.  This application must be submitted to the Real Estate Commission office with the appropriate examination fee.

I hereby make application to take the Real Estate examination as required under the provisions of Sub-section (2)

of Section 81-885.14 of the Nebraska Real Estate License Act which provides, in part, as follows: Any license

which has been inactive for a continuous period of more than three years shall be reinstated only if the licensee

has met the examination requirement of an original applicant.

Name

                           Last                                     First                          Middle                  Soc. Sec. #

      Residence Address Street Number - Mailing Address                                City

    County                                 State                               Zip                           Telephone No.

         For which license are you seeking reinstatement? Broker Salesperson

     (Date of Birth)

Sample Copy
By choosing to complete and submit this Online Application, I understand that any false information will be sufficient reason for rejection of my application. I further understand that any false information contained in this application may be a basis for revoking or suspending a license, if granted.
Submission of this Online Application will serve as authorization to release any and all information recorded on or attached with this application for licensing purposes to any state or federal investigative agency.
Submission of this Online Application means I expressly agree that the Nebraska Real Estate Commission reserves the right to go outside this application for information as to my trustworthiness and competency to act as a Real Estate Broker or Salesperson, as indicated above, in the State of Nebraska.
Submission of this Online Application authorizes any agency of federal, state or local government, consumer reporting agency, present or former employer, or any other individual, partnership, corporation, association, or educational institution, in this or any other state to furnish to the Nebraska Real Estate Commission, or its representatives, any information bearing upon my reputation for honesty, trustworthiness, integrity, and competence to transact the business of a real estate broker or salesperson, as indicated above, in such manner as to safeguard the interest of the public and answer any and all questions that may be asked and herewith hold such persons harmless for giving any and all information within their knowledge or records. Such information may include, but is not limited to, records of arrest for criminal offenses, the circumstances involved in any such arrest, the suspension or revocation of any license authorizing me to engage in any profession or occupation, or the rejection of my application for any such license, and the reasons for such suspension, revocation, or rejection.
Submission of this Online Application verifies that the statements herein are true, made for the purpose of procuring a Nebraska Real Estate Broker or Salesperson’s License, as indicated above, and will be relied upon as true by the Commission in reviewing and acting on this Online Application. I hereby consent that these statements may be used as evidence by the Real Estate Commission of the State of Nebraska or in any court in Nebraska where a violation of the said Real Estate Law is claimed, and that the application and representations made by me in order to procure a Real Estate Broker or Salespersons License, as indicated above, and the statements herein made to said Real Estate Commission may at any time be used in evidence.
Sample Copy

                             Dated

Applicant's Name


NO OTHER INFORMATION REQUIRED UNLESS SPECIFICALLY REQUESTED.