BROKER-MULTI-LICENSEE-RECIPROCAL INITIAL LICENSE

01/2017

BROKER-MULTI-LICENSEE-RECIPROCAL INITIAL LICENSE APPLICATION

Make sure this is the most recent application by checking our website. Failure to submit a current

application could result in delays while processing your application.

PLEASE READ THE FOLLOWING BEFORE PROCEEDING WITH THE APPLICATION PROCESS

This application is used to apply for a broker of record, broker-officer, or broker-partner license.

If your state of licensure is not listed do not proceed with this application. You will need to apply for the

Broker-Multi-Licensee-Standard license. The Pennsylvania Real Estate Commission has reciprocity with the

following states:

Arkansas Georgia Louisiana Maryland

Massachusetts New York West Virginia

If you are applying to be a broker of record for a corporation, LLC or partnership that was licensed by the

standard method, do not proceed with this application. Reciprocal brokers cannot be the broker of record

for a standard entity license holder. You must apply for the Broker-Multi-Licensee–Standard license.

To qualify for a reciprocal license you must maintain a current license in your primary state. You are

required to notify the Commission within 30 days of any change to your primary license. If your primary

license is not active at the time of renewal, you cannot renew, and must apply for a standard license.

You must meet both of the following requirements:

1. Hold a current, active equivalent license in another state, having been so obtained by

examination in a state that has entered into a reciprocal agreement with this Commission,

2. Your principal place of business is in another state

Applicants must be at least 21 years of age.

Licensees who wish to use and advertise a nickname for their first name shall include the nickname on

their licensure applications or biennial renewal applications.

If a pending application is older than one year from the date submitted and the applicant wishes to

continue the application process, the Commission shall require the applicant to submit a new application

including the required fee.

In order to complete the application process, many of the supporting documents associated with the

application cannot be more than six months from the date of issuance. All background check documents

cannot be older than 90 days from the date of issuance.

Failing to answer any questions or providing false answers may delay the issuance of a license or result in

disciplinary action once the license is issued.

SOCIAL SECURITY NUMBER DISCLOSURE: NOTICE: Disclosing your Social Security Number on this

application is mandatory in order for the State Boards to comply with the requirements of the Federal

Social Security Act pertaining to Child Support Enforcement, as implemented in the Commonwealth of

Pennsylvania at 23 Pa.C.S. § 4304.1(a). At the request of the Department of Human Services (DHS), the

licensing boards must provide to DHS information prescribed by DHS about the licensee, including the

social security number.

STATE REAL ESTATE COMMISSION

PO Box 2649

Harrisburg PA 17105-2649

Phone Number 717-783-3658

Fax Number: 717-787-0250

www.dos.pa.gov/estate

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Licenses are not forwarded. Provide your current address to receive correspondence from the

Commission. It is the applicant’s responsibility to inform the Commission of an address or name change

within ten (10) days of the change. Refer to the “Name/Address Change” form located on our website.

PLEASE NOTE: Providing your e-mail address on this form permits the Commission to

correspond with you via e-mail regarding the status of this application. Please make sure to

add ra-realestate@pa.gov to your Contacts so that you do not miss vital communications

regarding your license.

INSTRUCTIONS

1. The application responses must either be typed or printed in blue or black ink.

2. If you are a currently licensed PA broker applying for licensure as broker of record for a corporation

or partnership that is already licensed in this Commonwealth:

a. The corporation or partnership must obtain a resignation letter from the former broker of

record, to be submitted with this application; AND

b. The new broker of record must be identified as a signatory on the escrow account, replacing

the former broker of record. A letter from the bank confirming this change must be

submitted with this application; AND

c. The new broker of record may start practicing upon submission of this application.

3. If you are applying for licensure as broker of record for a corporation or partnership that is not

licensed in this Commonwealth, a completed application for a Broker (Corp LLC Partner) license

must also be submitted. YOU MAY NOT PRACTICE UNTIL THE COMMISSION ISSUES YOUR

LICENSE.

4. If you hold an active license issued by the PA Real Estate Commission, you do not need to submit a

state police background check.

5. If you hold a current PA salesperson or associate broker license, it will become inactive upon

issuance of your broker license.

6. Employer Certification – The employer certification must be signed by the broker or broker of

record if the employing broker is a corporation or partnership. If you are applying to be the

broker of record, this section may be left blank.

7. Broker Information - Use the name, address, and license number exactly as it appears on the

broker’s license. If the employing broker is a corporation or partnership, use the company’s name,

address, and license number.

APPLICATION CHECKLIST

Attach the following documents to this application:

 Check or money order made payable to the Commonwealth of Pennsylvania.

 $119.50 – Includes $94.50 licensure fee and $25.00 application fee.

 If you have NEVER held another Pennsylvania real estate license, ADD $10.00 for the

recovery fund fee = $129.50

 All fees are NON-REFUNDABLE regardless of whether a license is issued. A $20.00

processing fee will be charged for any returned unpaid check.

 Certification of Licensure/Letter of Good Standing – Accompanying this application must

be a Certification of Licensure or Letter of Good Standing from the state where you passed the

real estate broker licensure examination and that has a reciprocal agreement with this

Commission. The Certificate/Letter MUST be dated within 90 days of the date this application is

received in the Commission office.

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 Criminal Background Check completed by the State Police where the applicant resides

and dated within 90 days of the date this application is received in the Commission

office.

 If you reside in Pennsylvania, background checks may be obtained online at:

https://epatch.state.pa.us

 If you reside outside the state of Pennsylvania, you must obtain a background check

from the State Police in that state.

 The background check must contain the Applicant’s date of birth and social security

number.

 The background check must either state “No Record” or “Record Exists.” Background

checks that reflect “Pending” “Under Review,” or “Under Request” cannot be

submitted. Questions regarding the status of a background check must be directed to

the State Police.

 If “Record Exists”—submit originals of the following for EACH conviction:

o The conviction summary information provided by the State Police;

o Certified copies of ALL court documents;

o Letter from the probation office, dated within 90 days, indicating current

probationary status/completion date;

o Employment History (resume);

o Detailed description (in applicant’s words) of the circumstances surrounding the

conviction, the basis for the conviction and the disposition of the conviction;

o A signed and dated reference letter from the employing broker, on the company’s

letterhead, indicating that the broker is aware of all conviction(s) and is willing to

hire the applicant;

o Two signed and dated character references from individuals who are not related

to or residing with the applicant.

 Documentation regarding discipline (if applicable). If your real estate license in another

state or other professional license in any state has been the subject of discipline, submit all

documentation related to the disciplinary action.

 Resignation Letter (if applicable) - From previous broker of record.

 Escrow Letter (if applicable) - Verifying that the previous broker of record has been

removed as a signatory, and that the new broker of record has been added. (Does not apply to

officer/partner applicants).

PROCESSING INFORMATION

 Licenses are mailed to the employing broker’s main office address.

 Please see the Commission’s website www.dos.pa.gov/estate for additional information about

licensure and application requirements.

 To check the status of your application or to apply online visit www.mylicense.pa.gov

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BROKER-MULTI-LICENSEE-RECIPROCAL INITIAL LICENSE APPLICATION

Select the License Type:

 BROKER OF RECORD  BROKER OFFICER  BROKER PARTNER

1. Applicant’s Legal Name:

2. Applicant’s Nickname (if applicable):

3. Applicant’s Home Address:

(Street)

(City) (State) (Zip)

4. Applicant’s Email Address:

PLEASE NOTE: Providing your e-mail address on this form permits the

Commission to correspond with you via e-mail regarding the status of this

application. Please make sure to add ra-realestate@pa.gov to your Contacts so

that you do not miss vital communications regarding your license.

5. Applicant’s Social Security Number: __ __ __ - __ __ - __ __ __ __

6. Applicant’s Date of Birth: __ __ / __ __ / __ __ __ __

7. Applicant’s Phone Number: (__ __ __) __ __ __ - __ __ __ __

8. Select your state of reciprocity:

 Arkansas  Georgia  Louisiana  Maryland  Massachusetts  New York  West Virginia

BROKER INFORMATION AS IT APPEARS ON THEIR LICENSE

9. Employing Broker’s Office Name:

10. Employing Broker’s Office Address:

11. Employing Broker’s Office License Number:

(RBR #)

APPLICANT BACKGROUND INFORMATION:

12. Do you hold, or have you ever held, a license, certificate, permit, registration or other authorization

to practice a profession or occupation in any state or jurisdiction?  No  Yes

13. If you answered yes to the above question, please provide the profession_______________ and

state or jurisdiction _______________. Please do not abbreviate.

14. Have you had disciplinary action taken against a professional or occupational license, certificate,

permit, registration or other authorization to practice a profession or occupation issued to you in any

state or jurisdiction or have you agreed to voluntary surrender in lieu of discipline?  No  Yes

15. Do you currently have any disciplinary charges pending against your professional or occupational

license, certificate, permit or registration in any state or jurisdiction?  No  Yes

STATE REAL ESTATE COMMISSION

PO Box 2649

Harrisburg PA 17105-2649

Phone Number 717-783-3658

Fax Number: 717-787-0250

www.dos.pa.gov/estate

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16. Have you withdrawn an application for a professional or occupational license, certificate, permit or

registration, had an application denied or refused, or for disciplinary reasons agreed not to apply or

reapply for a professional or occupational license, certificate, permit or registration in any state or

jurisdiction?  No  Yes

17. Have you been convicted (found guilty, pled guilty or pled nolo contendere), received probation

without verdict or accelerated rehabilitative disposition (ARD), as to any criminal charges, felony or

misdemeanor, including any drug law violations? Note: You are not required to disclose any ARD or

other criminal matter that has been expunged by order of a court.  No  Yes

18. Do you currently have any criminal charges pending and unresolved in any state or jurisdiction?

 No  Yes

Disciplinary action includes any revocation, suspension, voluntary surrender, reprimand, probation, civil

penalty or any restriction in practice. If any disciplinary action has been taken against any license in any

state, submit all documentation about the disciplinary action.

Conviction includes a finding or verdict of guilt, an admission of guilt, a plea of nolo contendere or

receiving probation without verdict, disposition in lieu of trial or an Accelerated Rehabilitation Disposition

in the disposition of criminal charges. Only felony and misdemeanor convictions must be reported to the

Commission. If a conviction has occurred in any state that has not yet been reported to the Commission,

submit all documentation about the conviction. If you answered “Yes” to any of the disciplinary or

conviction questions, provide complete details as well as certified copies of relevant documents.

EMPLOYER’S CERTIFICATION

I do hereby request that a license be granted to ___________________________________________ to

provide real estate services at this office. I certify that the above applicant bears a good reputation for

honesty, trustworthiness, integrity and competence and I will actively train and supervise the applicant

as required by the Real Estate Licensing and Registration Act and the Commission’s Regulations.

(Broker’s Signature) (License Number) (Date)

APPLICANT’S CERTIFICATION

By submitting this information, I verify that this application is in the original format as supplied by the

Department of State and has not been altered or otherwise modified in any way. I am aware of the

criminal penalties for tampering with public records or information under 18 Pa.C.S. § 4911. I verify that

the statements in this application are true and correct to the best of my knowledge, information and

belief. I understand that false statements are made subject to the penalties of 18 Pa.C.S. § 4904

(relating to unsworn falsification to authorities) and may result in the suspension, revocation or denial of

my license, certificate, permit or registration.

(Applicant’s Signature) (Date)