Independent Broker Forms

Independent Broker Application

Please download and complete the Employment Packet, Background check form, IRS W-9 form as well as the Federal I-9 form, which verifies Employment Eligibility. Please email the completed forms to or Fax to (631) 789-7383.

Upon receipt and revision of the application, we will contact you to schedule your fingerprinting appointment. The Justice Center sends the result of the background check to Halo Network, Inc.

To complete the sign-up process, we will schedule an appointment for you to bring your Government Issue-ID and Social Security Card to one of our 2 offices on Long Island.

Important: Please provide broker certificates along with application

Employment Packet


Background Check Form


IRS W-9 Form


Federal I-9 Form