NEW JERSEY REAL ESTATE COMMISSION
EDUCATION BUREAU
PO BOX-328
TRENTON, NEW JERSEY 08625-0328
REAL ESTATE PRE-LICENSE INSTRUCTOR APPLICATION
FOR LICENSES ISSUED IN FIRST YEAR
OF TWO-YEAR TERM: *
FOR LICENSES ISSUED IN SECOND
YEAR OF TWO-YEAR TERM: *
APPLICATION FEE:
LICENSE FEE:
TOTAL:
APPLICATION FEE:
LICENSE FEE:
TOTAL:
$ 50.00
200.00
$250.00
$ 50.00
100.00
$150.00
*N.J.S.A. 45:15-10.7 Application for issuance of license as a Real Estate Instructor; fees
_____________________________________________________________________________________
INSTRUCTIONS
Each completed application must be accompanied by the fee and presented to the Commission on the day of
the seminar. The “Universal Form with receipt” must also be attached with this application if it has not
previously been submitted to the Real Estate Commission’s Education Bureau.
Fee payment must be in the form of money order, Cashier’s check, Certified check or Broker’s
business check. Made payable to “Treasurer, State of New Jersey NO PERSONAL CHECKS
ACCEPTED
.
PLEASE TYPE OR PRINT CLEARLY
_____________________________________________________________________________________
Name of Applicant (Last Name, First Name, MI)
_________________________________________________________________________________________________________
Home Address of Applicant
Street
Apt. No.
_________________________________
City
Home Phone:
_______________
_______________________
Zip
(____)_________________
County
Daytime Phone:
(____)_________________
Email address __________________________________________________________________________
_________________________________
_________________________________________
Social Security No.
Date of Birth (MM-DD-YY)
*Disclosure of your Social Security Number is mandatory for child support enforcement purposes. The
Commission’s authority to compel disclosure of Social Security Numbers is established at P.L. 1996, c.7
and N.J.A.C. 11:5-3.5.
__________________________________________________________
License Reference No. (if NJ Real Estate Licensee)
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Page Two
Instructor Application
ALL QUESTIONS MUST BE ANSWERED
1. With the exception of motor vehicle violations, have you ever been convicted of a crime,
misdemeanor, or disorderly persons offense by the state of New Jersey, any other state or the
federal government, or are you presently on probation or parole?
Yes_____ No_____
2. Is there a criminal complaint, disorderly persons charge, criminal accusation or criminal
information presently pending against you or are you presently under indictment in New
Jersey, any other state or by the federal government or are you presently enrolled in New
Jersey’s Pre-Trial Intervention (PTI) program or any similar State or Federal program
involving the deferral of the disposition or sentencing in a criminal matter?
Yes_____ No_____
3. Have you ever had a real estate or other professional license, certification or similar
credential revoked, suspended, surrendered in lieu of formal prosecution, or denied in New
Jersey or any other state?
Yes_____ No_____
4. Do you have a child support obligation on which there is an arrearage due that equals or
exceeds the amount of child support payable for six months or are you the subject of a child
support related warrant, or during the past six (6) months have you failed to provide any
court-ordered health care coverage, or have you failed to respond to a subpoena relating to a
paternity or child support proceeding?
Yes_____ No_____
5. Are you UNDER the age of 18 at the time of filing this application?
Yes_____ No_____
6. Do you now hold, or have you ever held, ANY license issued by the NJ Real Estate
Commission?
Yes_____
7.
No_____
Are you a high school graduate or the holder of a G. E. D.?
Yes_____
No_____
8. Do you currently hold a real estate license issued by another state?
Yes_____
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Revised 9/06
No_____
Page Three
Instructor Application
_____ Check this area if you answered yes to question(s) 1, 2, or 3 and provide all
necessary documentation such as copy of any indictment, judgment of conviction or order
of revocation/suspension. Also, provide with a written letter of explanation.
_____ Check area if you answered “yes” to question 4, pertaining to your child support
obligation and submit the following:
1. A written statement explaining in detail of the matter(s) referred to in question 4,
including an indication of the county and state with jurisdiction to enforce your
child support obligation;
2. Copies of any orders or consent agreements imposing the child support obligation.
SUBMISSION OF FALSE INFORMATION ON THIS FORM MAY SUBJECT
YOU TO SANCTIONS BY THE NEW JERSEY REAL ESTATE COMMISSION.
I CERTIFY THAT THE INFORMATION CONTAINED ON THIS APPLICATION AND ALL
ATTACHMENTS IS TRUE AND CORRECT, AND THE REAL ESTATE COMMISSION MAY
RELY ON ITS TRUTHFULNESS IN CONSIDERING THIS APPLICATION.
I FURTHER CERTIFY THAT I AM A CITIZEN OF THE US OR LEGALLY PRESENT IN THIS
COUNTRY AND THAT MY RESPONSES TO THE “SCREENING QUESTIONS” ON MY EXAM
DATE WERE TRUE AND REMAIN UNCHANGED AS OF TODAY, AND THAT I HAVE
INFORMED THE COMMISSION ABOUT: ANY PRIOR CONVICTIONS AND/OR CRIMINAL
CHARGES NOW PENDING AGAINST ME; ANY PAROLE OR PROBATION I AM NOW
SERVING; ANY REVOCATIONS, SUSPENSIONS, SURRENDERS FOR CAUSE OR DENIALS
OF ANY PROFESSIONAL LICENSE; AND/OR CHILD SUPPORT ARREARAGAES THAT
EXCEED 6 MONTHS OR CHILD SUPPORT-RELATED WARRANTS OUTSTANDING
AGAINST ME.
Any question pertaining to the certification of the above statement, please contact
the Education Bureau at 609-292-7272.
__________________________________
Date
______________________________________________
Print Name of Applicant
______________________________________________
Signature of Applicant
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