Out Of State License Application (Broker) {COM 3618}

Pl Please visit our website at www.com.ohio.gov/real 614|466 - 4100 Fax: 614|644 - 0584 TTY/TDD: 800|750 - 0750 Anne M. Petit , Superintendent BROKER RECIPROCITY APPLICATION LICENSE QUALIFICATION PROCESS In order to obtain an Ohio real estate license by reciprocity, you must do the following:1. Confirm that your state has entered into a limited reciprocity agreement with the State of Ohio.2. Must be a legal resident of a state that has a reciprocal agreement with Ohio.TO QUALIFY TO SIT FOR THE EXAMINATION1. Complete and return the Broker Reciprocity Application and the Non-Resident Real Estate Licensee Consent to Service of Process as specified in section 4735.17(B) of the Ohio Revised Code.2. Submit with your application a letter of certification from the state in which you are currently licensed certifying your status as a Broker and verifying that you have been continuously licensed in that state for at least two of the past five year.3. Submit with your application proof of completion of forty (40) hours of Ohio real estate law pre-licensure education as specified in Section 4735.09(F)(7)(b) of the Ohio Revised Code.After the Division has determined your eligibility to sit for the jurisdictional portion of the Real Estate Broker Examination, the examination. Information on scheduling your exam and test locations will be detailed in the You www.psiexams.com.Mail the completed Salesperson Reciprocity Application with required documents and $100 nonrefundable check or money order, made payable to the Ohio Division of Real Estate, to the following address:Ohio Department of CommerceDivision of Real Estate and Professional Licensing77 South High Street, 20th floorColumbus, OH 43215You will have one (1) year from the date you obtain your Ohio real estate license to complete the 10-hour Post Licensure course at an institution of higher education or at a Division-approved education provider. This course must be taken in a classroom setting at an institution of higher education. A list of some approved providers can be found atthe www.com.state.oh.us/real. Thereafter, you must complete 30 hours of continuing education every three (3) years at a Division-approved continuing education provider. Courses submitted by providers not approved by the Division can be submitted for approval for $100 per course.NOTICE: Per R.C. Section 149.43, this application and the information contained therein, except for the social security number, is public record.NOTICE: Evidence that payment has been refused by the drawer's bank upon a check drawn to the order of the Ohio division of real estate shall constitute prima facie evidence of misconduct and shall constitute a violation of section 4735.18(A)(6) of the Revised Code. COM 3618 (Rev. 1/2016) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com BROKER RECIPROCITY APPLICATION This form is interactive. You may, before printing it, type your responses directly onto the form. Otherwise, this form must be typewritten or printed legibly in black ink. FEE: $ 10 0.00 Incomplete applications and applications that are filled out incorrectly will be returned for correction. FOR DIVISION USE ONLY Note: The name and date of birth on this application must match the name and date of birth on the g overnment issued photo identification you will use to identify yourself at the examination site. APPLICANT INFORMATION FIRST NAME MIDDLE NAME OR INITIAL LAST NAME SUFFIX SOCIAL SECURITY NUMBER HOME ADDRESS PHONE NUMBER DATE OF BIRTH CITY STATE COUNTY ZIP CODE YEAR OF HIGH SCHOOL GRADUATION OR G.E.D EMAIL ADDRESS ETHICAL CONDUCT AND LEGAL HISTORY PLEASE ATTACH A COMPLETE EXPLANATION FOR ANY QUESTIONS QUESTIONS CONCERNING PROFESSIONAL LICENSES APPLY TO ALL PROFESSIONAL LICENSES REGARDLESS OF PROFESSION. YES NO Have you ever been disciplined in any manner by any public entity or professional or trade association for any violation of any professional licensing law, regulation or ethical rule, including the Ohio Division of Real Estate? YES NO Have you ever been refused or denied any professional license or registration by any public entity, including the Ohio Division of Real Estate? YES NO Have you ever had any professional license revoked, suspended or limited in any way for any reason? YES NO Have you ever been notified by any public entity or professional or trade association that you were under investigation for any violation of any professional licensing law, regulation or ethical rule, including the Ohio Division of Real Estate? YES NO Have you ever been the subject of any unsatisfied judgments? YES NO Have you ever been convicted of, plead guilty to or been granted intervention in lieu of conviction for any unlawful conduct excluding minor traffic violations? EXPLAIN: THE APPLICANT MUST COMPLETE THE FOLLOWING CERTIFICATION I certify that all of the statements on this application and all of the attached materials are complete and accurate. I understand that any false statement on this form or the attached materials may subject me to criminal prosecution and the loss of my Ohio real estate license. SIGNATURE OF APPLICANT DATE COM 3618 (Rev. 1/2016) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Pl Please visit our website at www.com.ohio.gov/real 614|466 - 4100 Fax: 614|644 - 0584 TTY/TDD: 800|750 - 0750 Anne M. Petit , Superintendent REAL ESTATE CONSENT TO SERVICE OF PROCESS NON-RESIDENT REAL ESTATE LICENSEE CONSENT TO SERVICE OF PROCESS [R.C. 4735.17(B)] The undersigned NAME OF APPLICANT (type or print) , being a non-resident of Ohio, and [check one] an applicant for licensure an applicant for license renewal (including continuing education) a licensee who is a former resident of Ohio who does not have a current Non-Resident Real Estate Licensee Consent to Service of Process form on file with the Division pursuant to Section 4735.17(B) of the Ohio Revised Code does hereby irrevocably consent that suits and actions may be commenced against the above named applicant in the proper court of any county of this state in which a cause of action may arise or in which the plaintiff may reside by the service of any process or pleading authorized by the laws of this state on the superintendent of real estate, hereby stipulating and agreeing that such service shall be taken and held in all courts as valid and binding as if proper service had been made upon said applicant in this state. I certify that all of the statements on this application and all of the attached materials are complete and accurate. I understand that any false statement on this form or any of the attached materials may subject me to criminal prosecution and the loss of my real estate license. 1 SIGNATURE OF APPLICANT DATE COM 3637 (Rev. 02/2010) Page 3 of 3 1 Must be signed by the applicant or officer/member/partner/associate of the applicant corporation/company/partnership/ association who is authorized to bind same. American LegalNet, Inc. www.FormsWorkFlow.com