SIGNATURE OF CERTIFYING BROKER
PRINTED NAME OF CERTIFYING BROKER
BROKER'S RE LICENSE ID#
COMPANY OR CORPORATION NAME (IF ANY)
BUSINESS TELEPHONE NUMBER
1. APPLICANTS NAME — LAST, FIRST & MIDDLE
2. APPLICANT'S RE LICENSE ID#
3. APPLICANT’S RESIDENCE ADDRESS — STREET ADDRESS, CITY, STATE AND ZIP CODE
LIST NUMBER OF TRANSACTIONS COMPLETED DURING THE TIME SPECIFIED ON ITEM #10.
5. APPROXIMATE EARNINGS
6. DETAILED EXPLANATION OF TYPE OF LICENSED REAL ESTATE EXPERIENCE IF TRANSACTION NOT LISTED ABOVE.
7. DID APPLICANT HAVE OTHER EMPLOYMENT OR BUSINESS ACTIVITY?
IF YES, EXPLAIN.
8. WORK TIME DEVOTED
9. HOURS PER WEEK
10. CONTINUOUS EMPLOYMENT CERTIFICATION (MM/DD/YY)
STATE OF CALIFORNIA
RE 226 (Rev. 2/98)
DEPARTMENT OF REAL ESTATE
Please read instructions on reverse side before completing this form.
FOR LICENSED REAL ESTATE EXPERIENCE ONLY.
I hereby certify to the nature and scope of applicant’s activities while employed by me as a salesperson. Realizing that
a false certification is basis for suspension or revocation of my license under Sections 10177(a), 10177(f), and 10177(h)
of the Real Estate Law, I certify under penalty of perjury that the foregoing is true and correct.
RE 226 — Reverse
Read this form carefully before completing and signing.
This form is to be submitted with the Broker Examination Application (RE 400B) and the proper broker examination fee.
Items #1–10 are to be completed by the employing broker of the applicant.
Type or print clearly in ink.
If you electronically re-create this form to facilitate completion on a computer, please be advised that the form should not
be altered in any manner. To do so, could result in disciplinary action. Also, please make certain you do not delete any
preprinted information and are using the latest version of the form.