Real Estate Instructor Application For Original Approval

An image of the North Carolin Real Estate Seal.

Refer to Commission Rule 58H .0302: Application and Criteria for Original Prelicensing, Postlicensing, or Update Course Instructor Approval.
Do not use this form for Elective Instructor Approval: Refer to Rules 58H .0203 and 58H .0402 .
NOTES:
Use this form ONLY IF you:

have never been a Commission-approved instructor in NC,
OR
have been a Commission-approved instructor in NC and your approval expired more than 6 months ago.

If you have been an approved instructor in NC, and your instructor approval expired less than 6 months ago, do not use this form. Instead, use the instructor renewal form.
Contact the Education and Licensing Division (educforms@ncrec.gov) if you have questions.

PLEASE REVIEW RULE 58H .0302 PRIOR TO COMPLETING THIS FORM

Have you been a Commission-approved instructor in NC in the past?*

If YES, enter your Instructor Number*

NC Real Estate Broker License #*

Broker First Legal Name*

Broker Last Legal Name*

Mailing Address*

City*

State*

9-Digit Zipcode Lookup*

Preferred Phone #*

Preferred Email Address*

REAL ESTATE BROKERAGE AND/OR TEACHING EXPERIENCE

Select all that apply and attach information as required per Commission Rule 58H .0302(b) .
You must select at least 1 option.

Real Estate Brokerage Experience
An instructor applicant may qualify with two (2) years active full-time experience in real estate brokerage, including at least one year of brokerage experience in North Carolina, within the previous seven (7) years.

Secondary or Post-Secondary-Level Teaching Experience
An instructor applicant may qualify with three (3) years of instructor experience at a secondary or post-secondary level.

Approval as a Prelicensing or Postlicensing Instructor in Another Jurisdiction
An instructor applicant may also qualify based on teaching experience gained through Prelicensing or Postlicensing instructor approval in another jurisdiction.

REAL ESTATE BROKERAGE EXPERIENCE*

Provide details of all brokerage experience within the previous seven (7) years.

Select the number of employers you want to add.*

Employer #1

Name of Employer*

City*

State*

Dates of Employment

From Date*

To Date*

Supervisor/BIC First Name*

Last Name*

Phone*

Email*

Job Title*

Average Hours Per Week Devoted to Brokerage*

Approx. # of Total Trans/Overall Sales Volume*

Areas of Practice and Percentages of Time Devoted to Each*

Brief Description of Applicant’s Role/Duties*
*If you need additional space please upload an attachment.

Employer #2

Name of Employer*

City*

State*

Dates of Employment

From Date*

To Date*

Supervisor/BIC First Name*

Last Name*

Phone*

Email*

Job Title*

Average Hours Per Week Devoted to Brokerage*

Approx. # of Total Trans/Overall Sales Volume*

Areas of Practice and Percentages of Time Devoted to Each*

Brief Description of Applicant’s Role/Duties*
*If you need additional space please upload an attachment.

Employer #3

Name of Employer*

City*

State*

Dates of Employment

From Date*

To Date*

Supervisor/BIC First Name*

Last Name*

Phone*

Email*

Job Title*

Average Hours Per Week Devoted to Brokerage*

Approx. # of Total Trans/Overall Sales Volume*

Areas of Practice and Percentages of Time Devoted to Each*

Brief Description of Applicant’s Role/Duties*
*If you need additional space please upload an attachment.

SECONDARY OR POST-SECONDARY-LEVEL TEACHING EXPERIENCE*

Provide details of all teaching experience at the high school or collegiate level within the previous seven (7) years.

Select the number of teaching experiences you want to add.*

Teaching Experience #1

Name of Institution*

Location of Institution

City*

State*

Dates you taught as an Instructor

From Date*

To Date*

Curriculum Taught*

Instructor Status*

Hours taught per semester/year*

Teaching Experience #2

Name of Institution*

Location of Institution

City*

State*

Dates you taught as an Instructor

From Date*

To Date*

Curriculum Taught*

Instructor Status*

Hours taught per semester/year*

APPROVAL AS A PRELICENSING OR POSTLICENSING INSTRUCTOR IN ANOTHER JURISDICTION*

Submit certification of such approval held within the previous seven (7) years.*
*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2MBs.

Select your file

File name

CHARACTER

a. Criminal Offenses
Have you been convicted of any criminal offense (felony or misdemeanor) since your original broker license approval or last renewal (whichever occurred last) or is there any criminal charge now pending against you? You must report all offenses for driving while impaired and any other offenses classified as “criminal traffic” offenses. Exclude only minor traffic “infractions”.*

Provide a detailed written explanation in your own words describing the circumstances for each conviction/ pending charge. For a conviction, you must attach a copy of the court order of criminal record report showing disposition of the case. The Commission reserves the right to require the applicant to provide additional information, including a criminal record report from an agency acceptable to the Commission. *
*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2MBs.

Select your file

File name

Select your file

File name

a. Professional License Disciplinary Action
Have you been denied a real estate or other professional license or been disciplined by an occupational licensing agency (license suspended, revoked, surrendered, reprimanded, or otherwise disciplined) in N.C. or elsewhere; or are there currently any complaints pending against you in connection with any professional license that you hold? *

If “Yes”, Provide a detailed written explanation in your own words describing the circumstances for each disciplinary action and attach a copy of the licensing agency’s order (if the disciplinary agency was other than the NC Real Estate Commission). You must include information regarding any complaints filed with the NC Real Estate Commission. *
*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2MBs.

Select your file

File name

Select your file

File name

OUT-OF-STATE REAL ESTATE LICENSE

Do you hold or have you held a real estate license in another jurisdiction?*

Provide details regarding your out-of-state real estate license. Do not include NC real estate license history.

Select the number of jurisdictions you want to add?*

Jurisdiction #1

Dates you held a real estate license in this jurisdiction

From Date*

To Date*

State license is/was held (Not NC)*

License #*

Type of License held*

Is this License Active?*

Jurisdiction #2

Dates you held a real estate license in this jurisdiction

From Date*

To Date*

State license is/was held (Not NC)*

License #*

Type of License held*

Is this License Active?*

Jurisdiction #3

Dates you held a real estate license in this jurisdiction

From Date*

To Date*

State license is/was held (Not NC)*

License #*

Type of License held*

Is this License Active?*

COLLEGE EDUCATION

Do you have a college degree from an institute that holds an accreditation that is recognized by the U.S. Department of Education? *

Provide the name and location of the institution you attended, your major, and the degree awarded.

Select the number of institutes you attended*

Institution #1

Name of School*

City*

State*

Major*

Degree*

Institution #2

Name of School*

City*

State*

Major*

Degree*

Submit information that demonstrates your completion of at least 60 semester hours of college-level education, including: *

Name of institution that holds an accreditation that is recognized by the U.S. Department of Education
Location of institution (City, State)
Dates attended
Semester hours completed

Note: You may submit information from multiple institutions and areas of study, if necessary.

*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2MBs.

Select your file

File name

NEW INSTRUCTOR SEMINAR

Enter the date you successfully completed the New Instructor Seminar within the previous 6 months*

UPDATE INSTRUCTOR SEMINAR

Update instructors must attend the annual Update Instructor Seminar prior to teaching any Update courses. Your Update Instructor approval will be on INACTIVE status until you complete the seminar for the current year in which you plan to teach.

I understand that I am not permitted to teach an Update course until I have completed the appropriate Update Instructor Seminar. *

Additional Documentation

If you have additional documentation you would like to submit with this applicaton you can upload the file(s) here.
*Accepted File Types: .txt .pdf .docx .doc
*Max file upload size 2MBs total.

Select your file

File name

Select your file

File name

EMPLOYEE MISCLASSIFICATION

Read the Public Notice Statement. Click the box to certify that you have read the statement, and select Yes or No in response to the question regarding investigations. If you select Yes, you will be required to provide information regarding the case(s). If you have questions regarding this section, please direct them to the North Carolina Industrial Commission. Contact information is provided on the page.

As required by the NC state legislature in NCGS § 143-765, effective January 1, 2018, in order to apply for or renew an occupational license, permit, or certification, the applicant must certify that they have read and understand the public notice statement from the Employee Classification Section of the State Industrial Commission and must disclose any investigations for employee misclassification.

Public Notice Statement
required by N.C. Gen. Stat. § 143-764(a)(5), effective December 31,2017

Any worker who is defined as an employee by N.C. Gen. Stat. §§ 95-25.2(4)(NC Department Of Labor), 143-762(a)(3)(Employee Fair Classification Act), 96-1(b)(10)(Employment Security Act), 97-2(2)(Workers’ Compensation Act), or 105-163.1(4)(Withholding; Estimated Income Tax for Individuals) shall be treated as an employee unless the individual is an independent contractor. Any employee who believes that the employee has been misclassified as an independent contractor by the employee’s employer may report the suspected misclassification to the Employee Classification Section within the North Carolina Industrial Commission.

Employee Classification Section
North Carolina Industrial Commission
1233 Mail Service Center
Raleigh, NC 27699-1233
Telephone: (919) 807-2582
Fax: (919)715-0282
Email: emp.classification@ic.nc.gov

Employee misclassification is defined as avoiding tax liabilities and other obligations imposed by Chapter 95, 96, 97, 105, or 143 of the North Carolina General Statutes by misclassifying an employee as an independent contractor.N.C. Gen. Stat. § 143-762(5)

I certify that I have read and understand the Public Notice Statement.*

During the past year, have you been the subject of an investigation for employment misclassification by a government entity? *

If YES, please provide the investigating entity, case or file number, if known, and the results of the investigation.*
Max 2000 characters

SIGNATURE AND CERTIFICATION OF APPLICANT

I certify that the information provided in this application is accurate to the best of my knowledge. I understand that any omission, inaccuracy, or failure to make full disclosure constitutes grounds for denial or withdrawal of approval to teach the Commission’s Prelicensing, Postlicensing, or Update courses and may constitute grounds for disciplinary action against me in connection with any other license or approval I hold that was issued by the N.C. Real Estate Commission.

Signature Required*

(Type your name)

Date Signed

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