Renewal Application With Education Compliance Form {COM 3681}

Pl Renewal Application with Education Compliance Form Broker Renewal Fee: $180 Salesperson Renewal Fee: $135 Online Renewal: Go to www.https://elicense3.com.ohio.gov/ Log into our secure site under the Account tab with yourUser ID and Password. Click the Online Services menu button in the top right corner andclick Create/Resume a Renewal. Answer Ethical Conduct and Legal History questions. Pay your renewal fee online using a Visa or Mastercard. Credit card payments may not be taken over the telephone. Print out receipt page for your records. to make certain the renewal is timely filed. Mail-In Renewal: Section 1: Applicant Information I am renewing my (check one) Broker License ($180) FIRST NAME: MI: LAST NAME: HOME ADDRESS: CHECK IF NEW Complete the Renewal Application and the Continuing Education Compliance form. Answer the Ethical Conduct and Legal History questions. Sign and date the certification on page 1. Return the forms, along with the renewal fee and copies of your continuing education certificates, to the Division. Make the check or money order payable to The Ohio Division of Real Estate. Cash will not be accepted. Mail to: Ohio Division of Real Estate & Professional Licensing 77 S High St., 20th Fl. Columbus, OH 43215-6133Renewal Reminders: The Renewal Application and Education Compliance Form will not be accepted earlier than 60 days prior to your due date. If this is your first birthday since becoming licensed, your renewal is due, however your 30 hours of continuing education are not.File Number: Salesperson License ($135) File Number: DOB:PHONE : CITY: STATE: ZIP CODE: EMAIL ADDRESS: Section 2: Ethical Conduct and Legal History Questions apply to all professional licenses regardless of profession Since your most recent filing of an application for Ohio real estate licensure, renewal or transfer/reactivation application, have you: Yes No B een d isciplined in a n y m a nner b y a n y pu b lic e n tity or p r o f essional or tra d e association for a n y violation of a n y professional licensing law, r e g u lation or ethical r ule , including the Ohio Division of Real Estate ? Yes No B een r e fused or denied a n y professional l i cense o r regist r ation b y a n y public entity , including the Ohio Division of Real Estate ? Yes No Had any professional license revoked, suspended or limited in any way for any reason, including the Ohio Division of Real Estate? Yes No B een n o tified b y a n y public entity or pro f essional or tra d e ass o ciation that y ou were under investigation for a n y v iolation of a n y professional licensing law, r egulation or ethical rul e , including the Ohio Division of Real Estate ? Yes No B een the subject of a n y un s atisfied judgment s ? Yes No B een convicted o f, plead guilty to or been g r anted inter v e n tion in lieu of conviction for a n y unlawful conduct exclu d ing minor traffic v i o lation s ? Section 3: Applicant Certification I certify that all of the statements on this application and all of the attached materials are complete and accurate. I unde rstand that any false statement on this form or any attached materials may subject me to criminal prosecution and the loss of my Ohio real estate license. Signature of Applicant: X Date: COM 3681 (Rev. 8/2014 ) Page 1 Confirm and/or enter and upload your continuing education. American LegalNet, Inc. www.FormsWorkFlow.com Real Estate Continuing Education Compliance Form Pr oo f o f C on ti nu ing Ed u cati o n C o m p lia n ce m a y no t b e s ub mitted ea r lier t h an 60 d ays b e f o re t h e du e d a te. Each li c ens e e shall s ubmit p r oof to the s up e rinte n dent that the lic e n s e e h a s satisfactori l y comp l e ted thir t y (30) hours of con t i n ui n g edu c ati o n, inc l ud i ng the thr e e requi r ed c o urses in C i v il Rights, Core L a w , an d Canons of Ethics. Each li c ens e e w h o is se v en t y (70) years of a ge or o l der w i t hin a c o nti n ui n g edu c ati o n r e porti n g per i od shall s ubmit p r oof that the licen s ee h a s comp l e ted a to t a l of ni n e (9) h ours of continu i ng e d ucat i on, i n cl u d i n g the t h ree re q u ir e d c o urses in C i v il Rights, Core L a w , an d Canons of E t hics. A licens e e w h o is seven t y ( 7 0) y e ars of a g e or o l der d uri n g the reporti n g p eri o d w ho s e li c ense is i n Inactive status is exempt from the conti n ui n g edu c ati o n req u irements s p eci f ied i n this sect i on. Enter your name and file number (license number). List each course completed by completed the fields listed below. Attach copies of your education certificates Continuing Education Course Certificates must be maintained for a period of at least 6 years. Carry - Over Hours: List carry - over from your last reporting period, which you are using this reporting period under the Electives Section . List hours that you took this reporting period in excess of 30 hours in the Carry - Over Section, up to 10 hours. Full Name: File Number: Civil Rights Course (Minimum 3 Hours) Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Core Law Course (Minimum 3 Hours) Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Canons of Ethics Course (Minimum 3 Hours) Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Electives Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Additional Space Is Provided On The Next Page American LegalNet, Inc. www.FormsWorkFlow.com Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance TOTAL HOURS FROM PAGES 2 & 3 (MUST be at least 3 0) (Total h o urs for lic e nse e s over 70 ye a rs of age must be at least 9 ) LIST UP TO T E N HOURS OF C A RR Y - O VER E D U C A TI O N BE LO W. If y ou did not use all of the hours of the last class listed above to reach the 30 total hours, list that class first here w i th a n y of t he car r y over h o urs. Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Course Provider Ohio Certification Number Hours Course Title Date(s) of Attendance Total Number of Carry - Over Hours NOTICE: Thi s ap plic a tio n a n d t h e informa t io n cont a ine d the r ei n , e x c e p t fo r th e s o ci a l s e curit y number , i s publi c r e cor d p u rsuan t t o Ohi o R e vise d C od e 1 49.4 3 . NOTIC E : Re f us a l o f chec k pa y men t b y th e dra w s b an k ma y resul t i n a $10 0 fe e t o t h e supe r in t ende n t o r rej e c t io n o r w ithd r a w a l o f a pprova l o f t h i s ap p lica t i on. American LegalNet, Inc. www.FormsWorkFlow.com