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Salesperson The undersigned with the approval of the employing Broker member whose signature appears below, hereby submits and subscribes to the Constitution and By-Laws of the Board as well as such rules as may be adopted to that class of membership. (Mr.) (Mrs.) (Miss) Signature of Applicant (Ms.)____________________________________________________________ Firm Name___________________________________________________________________________ Business Address______________________________________________________________________ Zip Code_________________ Business Tel: ____________________ E-mail: Home Telephone No.______________ Have you held membership previously in this Board? Yes___ No____ Home Address________________________________________________________________________ Have you ever been convicted of a felony or pleaded guilty to such an offense? Yes___ No____ If yes, please explain______________________________________________________________________ Have you ever been convicted of a misdemeanor with respect to fiduciary responsibilities? Yes___ No____ If yes, please explain______________________________________________________________________ Salesperson's License Number____________________________________________________________ Residential____ Commercial _____ How long have you been Licensed as a Salesperson___________________________________________ Signature of Firms Principal Broker __________________________________________________
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