Exam/License Application Checklist

1 This Checklist may be used for either the salesperson or broker Exam/License paper applications . Read appropriate license instructions carefully (RE 435A or RE 436A). Application must list your legal name. Items to be included in your packet are listed below. Check off each item as you assemble your packet. Mail completed Application package and fee to:Department of Real Box 137001 Sacramento, CA 95813-7001 BROKER APPLICANTSR equired documents .. RE 436 Completed and signed by applicant. Documentation to establish examination courserequirements have been met. Refer to RE 423 for currentrequirements. Official transcripts. Course completion certificates. Documentation showing experience requirementshave been met. Please note that depending on yourcircumstances, one or more of the forms listed below may be required. RE 226 Documenting licensed experience. RE 227 Documenting non-licensed experience.

2 RE 228 Two RE 228's are required if unable toobtain broker's signature on RE 226 form. RE 237 (See below.) Completed by applicant andlive scan service operator. license fee Refer to RE 206 for current fees. Do notsend cash. Cashiers check, check, or money order made payable to: Department of Real Estate. RE 909 If paying by credit APPLICANTSR equired RE 435 Completed and signed by applicant. Official transcripts or course completion certificatesfor Real Estate Principles, Real Estate Practice and/orone other required course not needed, if previouslysubmitted. RE 237 (See below.) Completed by applicant andlive scan service operator. license fee Refer to RE 206 for current fees. Do notsend cash. Cashiers check, check, or money order made payable to: Department of Real Estate. RE 909 If paying by credit card. Titles of forms referenced by number. All of these forms are available on DRE s Web site at 206 Exam & Licensing FeesRE 226 Licensed Experience VerificationRE 227 Non-Licensed Experience VerificationRE 228 Experience CertificationRE 237 Live Scan Service Request (Applicant)RE 237B Fingerprint InformationRE 423 Examination Qualification Requirements RE 435 Salesperson Exam/License Application RE 435A Salesperson Exam/License InstructionsRE 436 Broker Exam/License ApplicationRE 436A Broker Exam/License InstructionsRE 243 license Application Demographic Survey (Voluntary)RE 909 Credit Card PaymentGENERAL INFORMATION Make two photocopies of the copy provided.

3 After fingerprints are completed the live scan service operator will retainthe original. You should return the second copy to DRE and keep the third copy for your of CaliforniaDepartment of Real Estate Exam/License Application ChecklistRE 216B (Rev. 10/21)GENERAL INFORMATION Apply for the real estate broker examination and the real estate broker license at thesame time. Do not submit photocopies of this form or fax this enclosed instructions (RE 436A) before completing and submitting this Application to ensure that you understand the requirements and that the proper qualifying documentation and Exam/License fee are submitted. Note: Fees submitted with this Application are not refundable or transferable. If you fail to qualify for or pass the examination within two years of the date this Application is filed, the fees will not be applied to any future DATE EXPIRATION DATE FEES $ $300 Total due to DREwith this $395 DATE EXAM PASSEDAPPLICANT INFORMATION1.

4 SOCIAL SECURITY NUMBER OR INDIVIDUAL TAXPAYER ID NUMBER (REQUIRED REFER TO PRIVACY NOTICE ON RE 436A)2. BIRTH DATE (MM/DD/YYYY)3. Have you ever applied for a California real estate exam?.. If YES, list examination ID#. (If known.).. NO YES_____4. APPLICANT S NAME (MUST BE YOUR LEGAL NAME) - LASTFIRSTMIDDLESUFFIX5A. MAILING ADDRESS STREET ADDRESS OR POST OFFICE BOX5B. CITY5C. STATE5D. ZIP CODE6. Do you reside in California?.. If NO, an RE 234 is required (Refer to RE 436A). YES NO7. CURRENT PHONE NUMBER (required)( )8. CURRENT EMAIL ADDRESS (required - PRINT CLEARLY)9. BUSINESS CELL PHONE NUMBER( )10. BUSINESS TELEPHONE NUMBER( )11A. ARE YOU CURRENTLY SERVING IN THE MILITARY? YES NO11B. ARE YOU CURRENTLY MARRIED TO, IN A DOMESTIC PARTNERSHIP, OR IN A LEGAL UNION WITH AN ACTIVE DUTY SERVICE MEMBER? YES NO (see RE 436A for expedited processing instructions)12A.

5 HAVE YOU PREVIOUSLY SERVED IN THE MILITARY? YES NO12B. IF YES, WERE YOU HONORABLY DISCHARGED? YES NO (see RE 436A for expedited processing instructions)13. Do you now hold or have you ever held a California real estate license ?.. If YES, complete 13A, B, C, and D below. YES NO13A. TYPE OF LICENSE13B. IDENTIFICATION NUMBER13C. EXPIRATION DATE13D. NAME ON LICENSEEXAMINATION INFORMATION14. When you are qualified for the examination would you prefer to useeLicensing to schedule your own examination date? YES Please notify me by email when I am qualified for the examination. NO Proceed to item of CaliforniaDepartment of Real EstateBroker Exam/License ApplicationRE 436 (Rev. 11/21)DRE RECEIVED DATEDRE USE ONLYLIC. IDEXAM IDDRE USE ONLYDRE USE ONLYDRE USE ONLY RESTRICTED VIOLATIONSFORM LETTER / NOTESEXAM PROCESSORDATE PROCESSEDSENDER/DATE SENTLICENSE PROCESSORDATE PROCESSEDSACRAMENTOFRESNOLOS ANGELES VICINITY OAKLANDSAN DIEGO OTHER:16.

6 EARLIEST DATE YOU CAN TAKE EXAM 17.(mm)(dd)(yyyy)15. EXAM AREA PREFERENCEI am requesting a reasonable accommodation; RE 413 & supporting documents are 436 Page 2 of 3 BACKGROUND INFORMATIONC arefully read and provide detailed answers to questions 25-28. You must provide a "yes" or "no" response to all questions, and completely and accurately provide the detailed information required. Attach additional sheets if you need more space. Each additional sheet must be signed by the applicant. Failure to disclose pertinent information may result in denial of your license Application and/or delays. 25. HAVE YOU EVER HAD A DENIED, SUSPENDED, RESTRICTED OR REVOKED BUSINESS OR PROFESSIONAL license (INCLUDING REAL ESTATE), IN CALIFORNIA OR ANY OTHER STATE? IF YES, COMPLETE ITEM YES NO26. ARE THERE ANY license DISCIPLINARY ACTIONS PENDING AGAINST A BUSINESS OR PROFESSIONAL license YOU HOLD AT THIS TIME? IF YES, COMPLETE ITEM YES NO27.

7 HAVE YOU EVER BEEN REQUIRED TO REGISTER AS A SEX OFFENDER PURSUANT TO THE PROVISIONS OF SECTION 290 OF THE CALIFORNIA PENAL CODE OR ANY COMPARABLE LAW OF ANY STATE OR GOVERNMENTAL UNIT? IF YES, COMPLETE ITEM YES NO28. HAVE YOU EVER BEEN ORDERED TO CEASE, DESIST AND/OR REFRAIN FROM DOING AN ACT(S), OR FROM VIOLATING A LAW, RULE OR REGULATION BY, OR CITED FOR A BREACH OF ETHICS OR UNPROFESSIONAL CONDUCT, BY AN ADMINISTRATIVE AGENCY OR PROFESSIONAL ASSOCIATION IN CALIFORNIA OR ANY OTHER STATE? IF YES, COMPLETE ITEMS YES NO29. DETAILED EXPLANATION OF ITEM 25, 26 AND/OR 28. IF NEEDED, EXPLANATION MAY BE PROVIDED BELOW ON ITEM TYPE OF LICENSE29B. license ID license EXPIRATION DATE29D. STATE29E. ACTION (revoked, etc.)29F. DATE OF ACTION29G. DATE ACTION TERMINATED29H. CODE SECTION VIOLATED NAME OF APPLICANTLICENSE INFORMATION18. HAVE YOU USED ANY OTHER NAMES ( , MAIDEN NAME, FORMER MARRIED NAMES, AKA S, ETC.)

8 ? YES IF YES, LIST ALL NAMES USED: _____ NO 19. INITIAL WORKING STATUS (Must check one) YES. PLEASE ISSUE MY license IN A WORKING STATUS WITH THE MAIN OFFICE ADDRESS AS INDICATED ON ITEMS 20-23. WHEN MARKED "YES", ITEMS 20-23 MUST BE COMPLETED. NO. I DO NOT HAVE A MAIN OFFICE ADDRESS AT THIS TIME. PLEASE ISSUE MY license IN A NON-WORKING STATUS. DO NOT COMPLETE ITEMS 20-23. LEAVE ITEMS 20-23 BLANK. 20. MAIN OFFICE ADDRESS - STREET ADDRESS (MUST BE PHYSICAL ADDRESS)21. CITY22. STATE CA23. ZIP CODE24. FICTITIOUS BUSINESS NAME(S) (DBA) IF USING A FICTITIOUS BUSINESS NAME(S) INCLUDE A FILED COPY OF THE FICTITIOUS BUSINESS NAME STATEMENT(S) OB-TAINED FROM THE COUNTY CLERK FOR EACH NAME. REFER TO RE 436A FOR ADDITIONAL INFORMATION. I WILL USE A DBA DBA I WILL BE USING: _____ ADDITIONAL DBA OTHER DBA I WILL BE USING: _____ ADDITIONAL DBA OTHER DBA I WILL BE USING: _____30.

9 ADDITIONAL INFORMATION: SPECIFY WHICH LINES YOU ARE REFERRING TO. ATTACH EXTRA SHEETS IF MORE ROOM IS NEEDED. EACH ADDITIONAL SHEET MUST BE SIGNED BY 436 Page 3 of 3 NAME OF APPLICANTBROKER EXAM & license CERTIFICATIONExam I hereby certify under penalty of perjury that I am aware of and meet all examination requirements as set forth in Section 10153 of the B&P Code, and those set forth in RE 436A. I understand that the fees remitted will not be refunded or transfered under any circumstances per Section 10207 of the B&P Code. I also understand that subverting the examination will subject me to the penalties of Sections 123, , 496, , and of the B&P I certify under penalty of perjury under the laws of the State of California that the foregoing answers and statements given in this Application are true and correct, that at the time of license issuance I will be 18 years of age or older, that if licensed I will not violate any provisions of the Real Estate Law nor abuse the privileges of a real estate license .

10 I understand that the Department of Real Estate cannot refund the fees submitted with this Application , if I fail to qualify for the license for any reason or withdraw this hereby grant to the Real Estate Commissioner of the State of California and his/her authorized Department of Real Estate representatives, pursuant to Business and Professions Code 10145 and 10146, the authority to examine the financial records of any trust fund account that I maintain in a financial institution, wherever located, for any period of time in which I hold a real estate license or have the right to renewal of such real estate license or which relates to a transaction which occurred when I held such a real estate license . I understand that the information to be obtained from the financial records of my trust fund account(s) is for the purpose of aiding the Commissioner in his/her statutory duty to enforce the provisions of the Real Estate am aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for workers understand that it is my obligation to notify the Department upon licensure within 30 days in writing or by filing form RE 238 of any conviction, criminal complaint, information or indictment charging a felony, or disciplinary action taken by another licensing entity or authority of this state or an agency of the federal government pursuant to Business and Professions Code Section I also understand that the Department may delay my renewal and toll the expiration date of my license pursuant to B&P Section SIGNATURE OF APPLICANT (MUST BE ORIGINAL OR ELECTRONIC* DATE* Electronic signature must comply with California Uniform Transactions Act (CA Civ.))