Timothy Grissett
404-609-9898
tim@
timgrissett.com
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FIRST TIME VISITOR
General Information
All fields marked with an * are required
Date of application (mm/dd/yy) *
First name *
Last name *
Street address 1 *
Street address 2
City *
State or province *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip code *
How many years at this address?
Daytime phone *
Evening phone *
E-mail address *
Social security number *
Birthdate
Referred to this firm by
Former Residence
Show last 10 years - exclude military service
Most recent former residence
From date
To date
Address, city, state, zip
Second most recent former residence
From date
To date
Address, city, state, zip
Third most recent former residence
From date
To date
Address, city, state, zip
Education
High School
Name
Address
From date
To date
Major
Highest grade completed
College or University
Name
Address
From date
To date
Major
Highest grade completed
Other
Name
Address
From date
To date
Major
Highest grade completed
Misc
What specific courses have you had in the real estate field?
In what extracurricular activities did you participate while in school?
Employment Record
Begin with present or most recent employer, account for last 10 years
Most recent employment
Company name / nature of business
Address
Phone
From date
To date
Job title
Earnings
Reason for leaving
Second most recent employment
Company name / nature of business
Address
Phone
From date
To date
Job title
Earnings
Reason for leaving
Third most recent employment
Company name / nature of business
Address
Phone
From date
To date
Job title
Earnings
Reason for leaving
(Please continue in Comments section at end of application if more space is needed)
Organizational Activities
List business, social, and community activities for the last 5 years *
Activity one
Group name / type of organization
Location of activity
Offices held
Meetings per month
Activity two
Group name / type of organization
Location of activity
Offices held
Meetings per month
Activity three
Group name / type of organization
Location of activity
Offices held
Meetings per month
Activity four
Group name / type of organization
Location of activity
Offices held
Meetings per month
* If you wish, exclude any organization, the name or character of which indicates the race, color, religion, national origin or ancestry of its members
What are your hobbies?
References
List three persons in this vicinity who know you well and to whom we may refer (exclude relatives or previous employers)
Reference one
Name
Address
Phone
Occupation
Reference two
Name
Address
Phone
Occupation
Reference three
Name
Address
Phone
Occupation
Real Estate Experience
Complete this section only if you have had previous experience selling real estate
Do you have a real estate sales license?
Yes
No
If yes, what is the number?
Do you have a brokers license?
Yes
No
If yes, what is the number?
Are you, or have you been a member of a real estate board?
Yes
No
If yes, please answer the following
Board name
Dates of membership
List the individuals in our firm with whom you have had cooperative real estate transactions
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