Fillable Real Estate Broker Application Instructions (New York State)

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Real Estate Broker Application Instructions (New York State)

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Real Estate Broker Application – Instructions
Read the instructions carefully before completing the
application. Incomplete applications will be returned, delaying
licensure. Any omission, inaccuracy or failure to make full
disclosure in an application or supporting documentation may
be deemed sufficient reason to deny a license, or, if a license
is issued could result in the suspension or revocation of a
license.
Is there an age requirement to become a licensed Real Estate
Broker? Yes. Real Estate Broker applicants must be 20 years of
age or older.
Business Name Availability: Prior to filing this application, all
proposed names must be submitted, in writing, to the Division of
Licensing Services for approval. Upon approval of the name you
wish to use, you must then file the appropriate document with either
the respective County Clerk’s office or the NYS Department of
State, Division of Corporations. You may submit your request by
emailing eAccessNY@dos.ny.gov (mark “Name Availability” as the
subject line); or, mail to the address listed on the application, Attn:
Real Estate Unit. You will receive a response in the same manner
the request was submitted. You may list up to three unique names
in order of preference. All variations of a business name are subject
to our regulations (19 New York Codes Rules and Regulations).
Note: This Division does not “hold” or “reserve” names once they
have been approved for use. All applications are subject to review
when they are received.
Business Address: All applicants must list the address at which
they will be conducting business as a real estate broker. Sole use
of a post office box number as a business address is prohibited.
(For additional office locations, please refer to Branch Office
instructions on our website.)
What are the application fees, terms of licensure?
The nonrefundable application fee for a real estate broker license is
$155; the license will be effective for two years.
What forms of payment do you accept?
You may pay by check or money order made payable to the
Department of State or by MasterCard or Visa, using a credit card
authorization form. Do not send cash. Application fees are
nonrefundable. A $20 fee will be charged for any check returned by
your bank.
Where do I get the office license number requested on the
application?
With the implementation of our new real estate system, a number
has been assigned to the principal office location. The branch office
location is an actual license and has always been assigned a
license number. To obtain either the principal office license number
or the branch office license number, it can be located on the
Department’s website by using the public search function on the
new online system located at www.dos.ny.gov. It is important for
the processing of your application that you fill in the office license
number.
Why do I need to provide my email address on the
application?
In order to perform online transactions, you MUST provide
your current email address on page 3 of the application. Your email
DOS-0036-f-a (Rev. 08/19)
address will be used by our office to establish your online account.
If you have already established an online account by signing up to
take the state examination, it is important that you utilize the same
email address. If you change your email address in the future, you
should log in to your online account and update it with the new
email address. If you are submitting an application to our office, you
should indicate if your email address has changed since taking the
examination.
What types of Real Estate Broker licenses can I apply for?
Individual Broker: An individual broker is issued a license to do
business using his/her personal name only.
Associate Broker: An associate broker is a licensed broker who
shall by choice elect to work under the name and supervision of
another broker who is licensed to do business as an individual,
partnership, corporation, limited liability company, limited liability
partnership or trade name. Associate Broker applicants must have
the sponsoring broker sign the association statement which is
located beneath the “For Associate Broker Applicant’s Only”
portion of this application.
Trade Name Broker: A trade name broker conducts business as a
sole proprietorship, doing business as a name other than his/her
personal name. A business certificate must be filed with the
Office of the County Clerk where the business is located. By
signing the attached application, you are certifying compliance
with this requirement.
Partnership Broker: A partner or partners in a partnership may
apply for a real estate broker license to conduct business under the
partnership name. Any partner who wishes to engage in the
business of a real estate brokerage must be licensed as a real
estate broker. Each partner who wishes to be licensed as a real
estate broker must file an application and fee. A partnership
certificate must be filed in the Office of the County Clerk in the
county where the business is located. By signing the attached
application, you are certifying compliance with this
requirement.
Corporate Broker: An officer of a corporation may apply for a real
estate broker license to conduct business as a real estate
brokerage under the corporate or assumed name. Applicants must
be an officer prior to licensing. A Certificate of Incorporation,
Assumed Name or Application for Authority must be filed with
the NYS Department of State, Division of Corporations. By
signing the attached application, you are certifying compliance
with this requirement.
Limited Liability Company or Limited Liability Partnership: A
member or manager of the limited liability company or limited
liability partnership, who meets the qualifications for licensure, may
apply for a real estate license to conduct business as a real estate
brokerage under the limited liability company, assumed name or
limited liability partnership name. Applicants must be a member or
manager prior to licensing.
The Articles of Organization, Application for Authority,
Certificate of Assumed Name or Certificate of Registration
must be filed with the NYS Department of State, Division of
Corporations. By signing the attached application, you are
certifying compliance with this requirement.
Limited Partnership Broker: A partner or partners in a limited
partnership may apply for a real estate broker license to conduct
business under a limited partnership or assumed name. Any
Page 1 of 12
WOULD YOU LIKE TO REGISTER TO VOTE?
Please visit the NY State Board of Elections at www.elections.ny.gov/votingregister.html
or call 1-800-FOR-VOTE to request a NYS Voter Registration form.
To register online, please visit www.ny.gov/services/register-vote.
Real Estate Broker Application – Instructions
partner who wishes to engage in the business of real estate
brokerage must be licensed as a real estate broker. Each partner
who wishes to be licensed as a real estate broker must file an
application and fee. A Certificate of Limited Partnership or Assumed
Name must be filed with the NYS Department of State, Division of
Corporations. By signing the attached application, you are certifying
compliance with this requirement.
How do I qualify for licensure?
First Time Applicants: You may apply for a real estate broker
license based on Experience, Education and Examination,
Reciprocity, or if you are an Attorney who is currently admitted to
the New York State bar.
Experience, Education and Examination: You must have passed
the NYS Real Estate Broker exam and have at least two years of
experience as a licensed real estate salesperson or at least three
years of experience in the general real estate field (i.e., buying and
selling your own property, managing property owned by your
employer, etc.) You may apply with a combination of these types of
experience (see Attachment B). You must submit:
1. a completed application with application fee;
2. proof, in the form of signed school certificates bearing the raised
school seal, of 120 hours of approved qualifying course work (the
certificates issued by the school must state “approved by the
Secretary of State in accordance with the provisions of Chapter 868
of the Laws of 1977”) Note: The 75 hour salesperson qualifying and
30 hour remedial courses are only valid for 8 years past the course
completion date and must be used to obtain a license or will expire
and must be retaken.
Once either of these courses have been applied towards a license,
they will not expire and can be used for upgrade.
OR
you may submit the "Broker Course Certification" on Page 3
completed by the school coordinator.
3. experience supplement A, B or C.
Experience: You must meet one of the following experience
requirements to be eligible for licensure as a real estate broker. To
assure consistency and fairness in evaluating your qualifying
experience, the Department of State will utilize a point system which
takes into consideration the amount and type of qualifying activities
performed and assigns a weighted value to each function.
Determine which type of experience you will be claiming from the
chart below and fill out the corresponding experience supplement
(A, B or C).
If You Are Using Supplement A1/A2
(Licensed Real Estate Salesperson):
You must accumulate a minimum of 3500 points* to qualify for a
broker’s license based on experience as a real estate salesperson.
Applicants must also be licensed as a real estate salesperson for a
minimum period of 2 years*.
If You Are Using Supplement B1/B2
(Equivalent Experience)
You must accumulate a minimum of 5250 points* to qualify for a
broker’s license based on equivalent experience in general real
estate business. Applicants must also possess at least 3 years of
experience in the real estate business equivalent to that of an
active real estate salesperson*.
If You Are Using Supplement C
(Combined Experience)
You must accumulate a minimum of 5250 points to qualify for a
broker’s license based on combined experience in general real
estate business and licensed real estate salesperson experience.
Applicants must also possess at least 3 years of experience in the
real estate business equivalent to that of an active real estate
salesperson.
Examination: You must have passed the NYS Real Estate Broker
examination. You do not need to submit examination
documentation. Your examination results are available online and
will be verified when you submit your application. You must submit
your application within two years of examination; failure to do so
invalidates the results of the examination.
Reciprocity: New York State has a reciprocal agreement with
several states. If you are currently licensed as a real estate broker in
a state with which New York has an agreement, you may apply for a
New York State real estate broker license based on reciprocity. You
must submit:
1. a completed application with application fee;
2. a current certification (dated within six months, from the state
agency where you are currently licensed indicating current status as
a real estate broker in good standing (a copy of a current license is
not acceptable);
Attorneys who are admitted to the New York State bar are exempt
from the educational, experience and examination requirements.
Submit a completed application and fee, indicating on the
application that you are admitted to the New York State bar.
What are the continuing education requirements for a renewal
license?
A renewal license will not be issued unless you complete 22.5 hours
of Department of State approved continuing education within the
two-year period immediately preceding such renewal. The 22.5
hours must include at least three hours of instruction pertaining to
fair housing and/or discrimination in the sale or rental of real
property or an interest in real property and at least one hour of
instruction pertaining to the law of agency except in the case of the
initial two-year licensing term for real estate salespersons, two hours
of agency related instruction must be completed.
PRIVACY NOTIFICATION
Do I need to provide my Social Security and Federal ID numbers on
the application?
Yes. The Department of State is required to collect the federal
Social Security and Employer Identification numbers of all licensees.
The authority to request and maintain such personal information is
found in §5 of the Tax Law and §3-503 of the General Obligations
Law. Disclosure by you is mandatory. The information is collected to
enable the Department of Taxation and Finance to identify
individuals, businesses and others who have been delinquent in
filing tax returns or may have underestimated their tax liabilities and
to generally identify persons affected by the taxes administered by
the Commissioner of Taxation and Finance. It will be used for tax
administration purposes and any other purpose authorized by the
Tax Law and may also be used by child support enforcement
agencies or their authorized representatives of this or other states
established pursuant to Title IV-D of the Social Security Act, to
establish, modify or enforce an order of support, but will not be
available to the public. A written explanation is required where no
number is provided. This information will be maintained in the
Licensing Information System by the Director of Administration and
Management, at One Commerce Plaza, 99 Washington Avenue,
Albany, NY 12231-0001.
DOS-0036-f-a (Rev. 08/19)
Page 2 of 12
(For Office Use Only) (For Revenue Use Only) Application Fee: $155.00
New License Number
______________________________
Eff. Date: _______________
Real Estate Broker Application
If you do not complete all required responses, your application will be returned.
I am applying based on the following qualification * (X only one):
Attorney Admitted to NYS Bar Previously Licensed
Additional Broker License DOS Approved Qualifying Education
Reciprocity State of ___________________ and have provided a current certification (dated within 6 months) from the Real Estate
Commission where my license was obtained.
Please TYPE or PRINT all responses in ink APPLICANT INFORMATION * Required Responses
Applicant’s Last Name * First Name * M.I. Suffix
Home Address – Number & Street (Physical address required) * Apt/Suite
City * State * Zip + 4 * County *
Applicant’s SOCIAL SECURITY NUMBER * (See Privacy Notification) Applicant’s DATE OF BIRTH *
Applicant’s Phone Number * Applicant’s EMAIL ADDRESS *
Applicant’s New York State nine digit DMV ID # *
Note: Non NYS residents please see Page 12 "Checklist"
If you previously or currently hold a NYS real estate license issued
by the state of New York, please enter the UID/License #. *
BUSINESS INFORMATION * Required Responses
Business Name * (Name under which you will conduct business; see application
instructions for verifying name availability) FEIN Number
Business Address - Number & Street (Physical address required) * Daytime Phone Number
City * State * Zip + 4 * County *
DOS-0036-f-a (Rev. 08/19) Page 3 of 12
mm/dd/yyyy
Real Estate Broker Application
Place an X in ONE of the license types listed on this page:
I am applying as the representative (principal) real estate broker for a Trade Name, Partnership, Limited
Liability Company/Limited Partnership or Corporation:
As the principal/owner/partner, As the principal/member/officer,
I affirm the below business is filed with the I affirm the below business is filed with the
Office of the County Clerk Division of Corporations
Trade Name Limited Liability Company or Limited Partnership
(Conducts business as a sole proprietorship, doing business (Conducts business as a real estate brokerage under the Limited
as a name other than his or her own name). Liability Company, Limited Partnership or Assumed Name).
Partnership Corporation
(Conducts business under the partnership name only). (Conducts business as a real estate brokerage under the corporate
name or assumed name).
OR
I am applying as an:
Individual Broker (Conducts business as a real estate brokerage using his or her personal name only).
OR
I am applying as an:
Associate Broker (Conducts business under the name and supervision of an individual broker or a representative (principal) broker who is
licensed under a Partnership, Trade Name, Limited Liability Company or Corporation.).
FOR ASSOCIATE BROKER APPLICANTS ONLY: The sponsoring broker must print and sign their name as indicated below. In
addition, they must provide their License/Unique ID number as well as the Office License/ Unique ID number in which the applicant
will practice and date signed.
Association Statement – I am sponsoring this applicant.
Sponsoring Broker License/Unique ID Number *
Sponsoring Broker * ______________________________________________________________________________________________
(Print Name)
Sponsoring Broker * Date
(Signature)
Practice Location Office License/Unique ID Number *
(in which the applicant will practice) 1099
1039
*Required Information
DOS-0036-f-a (Rev. 08/19) Page 4 of 12
Real Estate Broker Application * Required Responses
1. Have you ever been convicted of a crime that is a misdemeanor or felony? * YES NO
IF “YES,” you must submit a written explanation and provide a copy of the court records detailing the allegations of the
offense and how the case was resolved. If you have received a Certificate of Relief from Disabilities, Certificate of Good
Conduct or Executive Pardon, you must submit a copy with this application.
2. Are there any criminal charges (misdemeanor or felonies) pending against you in any court? * YES NO
IF “YES,” you must submit a written explanation and provide a copy of the court records detailing the allegations of the
offense.
3. Has any license or permit issued to you or a company in which you are or were a principal ever been revoked, suspended or denied?
* YES NO
IF “YES,” you must provide all relevant documents, including the agency determination if any.
Child Support Statement
By signing this application, I certify that as of the date of this application, I am not under an obligation to pay child support.
OR
If I am under an obligation to pay child support, I/my
(1) am not four or more months in arrears in the payment of child support, or
(2) am making payments by income execution or by court agreed payment or repayment plan or by plan agreed to by the parties; or
(3) child support obligation is the subject of a pending court proceeding, or
(4) am receiving public assistance or supplemental security income.
Applicant Affirmation— I affirm, under the penalties of perjury, that the statements made in this application and in supplements A,
B and C if applicable are true and correct.
If you are currently a NYS Licensed Real Estate Associate Broker and are submitting this application for an additional Real Estate
Associate Broker license, by signing this application you are affirming all sponsoring brokers have provided their consent.
In addition, I hereby authorize the NYS Department of State and NYS Department of Motor Vehicles to produce an ID card bearing my
DMV photo. I understand that DOS and DMV will use my DMV photo to produce all subsequent ID Cards for as long as I maintain my
license with the Department of State and that I may withdraw my consent to use my DMV photo by submitting a request in writing to the
Department of State.
I (we) do hereby irrevocably submit to the jurisdiction of the courts of the State of New York and, further, hereby irrevocably designate
the Secretary of State of New York as its agent upon whom may be served any summons, subpoena and other process naming the entity
in any action or special proceeding commenced in the State of New York.
By this consent and designation, I (we) agree that service of process upon the Secretary of State shall be, in all respects, as valid and
binding as if personal service had been made upon the entity within the State of New York.
I affirm that I have a fair knowledge of the English language.
I further affirm that I have read and understand the provisions of Article 12-A of the Real Property Law and the rules and regulations
promulgated there under.
Applicant Print Name *
Applicant Signature* Date
DOS-0036-f-a (Rev. 08/19) Page 5 of 12
Real Estate Broker Application
Education
Applicants must have completed 120 hours of NYS Department of State/Division of Licensing
Services approved qualifying
education in the form of:
75 hour salesperson course and 45 hour broker course OR
45 hour salesperson course (completed prior to 07/01/08), 30 hour remedial course and 45 hour broker course.
The 75 hour salesperson qualifying and 30 hour remedial courses are only valid for 8 years and must be used to obtain a license or will
expire and must be retaken.
Once either of these courses have been applied towards a license, they will not expire and can be used for upgrade.
Broker Course Certification
Certification of Satisfactory Completion – 45 hr. Broker Course
This section must be completed by the school coordinator OR you may submit a copy of your course certificate.
Name of School
This certifies has satisfactorily completed a Real Estate 45 hour
broker qualifying course (Code) #B - This course was completed on
School Coordinator’s Signature Date
Sales Course Certification - Complete only if not currently licensed as a salesperson
Certification of Satisfactory Completion - 75hr. Salesperson Course or 45 hr. Salesperson Course
This section must be completed by the school coordinator OR you may submit a copy of your course certificate(s).
Name of School
This certifies has satisfactorily completed the Real Estate
75 hour
salesperson course (Code) #F - or 45 hour salesperson course #S -
This course was completed on
School Coordinator’s Signature Date
Sales Remedial Course Certification
(This section should only be completed if the 45 hr Salesperson Course was taken prior to 7/1/2008).
If you received a Course Waiver from Educational Standards at the Department of State, please submit a copy with this application.
DOS-0036-f-a (Rev. 08/19) Page 6 of 12
mm/dd/yyyy
Certification of Satisfactory Completion – 30 hr. Salesperson Remedial Course
This section must be completed by the school coordinator OR you may submit a copy of your course certificate.
Name of School
This certifies has satisfactorily completed a 30 hr.
salesperson
remedial qualifying course (Code) #R -
This course was completed on
mm/dd/yyyy
School Coordinator’s Signature Date
A1
1
Salesperson License/Unique ID Number
Real Estate Broker Application
Supplement A - Licensed Salespersons
Activity Worksheet
Instructions for Completing Supplement A: You must accumulate a minimum of 3500 points* to qualify for a broker’s license based on experience as
a real estate salesperson. Applicants must also be licensed as a real estate salesperson for a minimum period of 2 years*.
1. In the Number of Transactions Performed column, enter the amount of your activity for each category.
2. Multiply the number of transactions performed by the point value indicated to arrive at the points earned for that category.
3. Add the points earned for each category to arrive at your total points.
4. Enter the total figure on the Total Qualifying Points Line. This is your final qualifying points earned.
*Except those using combined experience.
You must also complete the Salesperson Employment History on the following page. Number of Total
Point Transactions Points
Category Value X Performed = Earned
Residential Sales:
1. Single Family, condo, co-op unit, multi family (2 to 8 unit), farm (with residence, under 100 acres) . . 250 X =
(The 250 points may be claimed by both the listing agent and the selling agent, provided such agent
was the procuring cause of bringing about the meeting of the minds.)
2. Exclusive listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X =
3. Open listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 X =
4. Binders effected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 X =
5. Co-op unit transaction approved by seller and buyer that fails to win Board of Director’s approval . . . 100 X =
Residential Rentals:
6. Rentals or subleases effected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 X =
7. Exclusive Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X =
8. Open Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 X =
9. Property Management - Lease renewal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 X =
- Rent collections per tenant/per year . . . . . . . . . . . . . . . 1 X =
Commercial Sales:
10. Taxpayer/Storefront . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
11. Office Building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
12. Apartment Building (9 units or more) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
13. Shopping Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
14. Factory/Industrial warehouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
15. Hotel/Motel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 400 X =
16. Transient garage/parking lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
17. Multi-unit commercial condominium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
18. Urban commercial development site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
19. Alternative sale type transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
20. Single-tenant commercial condo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 X =
21. Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X =
Commercial Leasing/ Financing (includes residential properties of more than four units):
22. New Lease - aggregate rental $1 to $200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 X =
23. New Lease - aggregate rental $200,000 to $1 million . . . . . . . . . . . . . . . . . . . . . 250 X =
24. New Lease - aggregate rental over $1 million . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
25. Renewal - aggregate rental $1 to $200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 X =
26. Renewal - aggregate rental $200,000 to $1 million . . . . . . . . . . . . . . . . . . . . . . . 125 X =
27. Renewal - aggregate rental over $1 million . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 X =
28. Listings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X =
29. $1 to $500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 X =
30. $500,000 to $5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 X =
31. Over $5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
Miscellaneous:
32. Sale vacant lots, land (under 100 acres) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 X =
33. Sale vacant land (more than 100 acres) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 X =
Total Qualifying Points Claimed
DOS-0036-f-a (Rev. 08/19) Page 7 of 12
A2
Real Estate Broker Application
Supplement A - Licensed Salespersons
Employment Worksheet
You must indicate all employment which is commensurate with the experience claimed on the Licensed Salesperson Activity Worksheet.
Each principal broker that you are claiming experience under must sign the certification and indicate points accumulated while working under
his/her sponsorship.
Salesperson Employment History
Salesperson Employment - I was actively engaged as a licensed real estate salesperson as indicated below:
Number of From: To:
Broker’s Name and Company Name and Address Hours/Week Month/Day/Year Month/Day/Year
All claimed transactions are subject to verification. In order to claim experience points, both the broker and salesperson applicant
must be able to provide documentation which clearly demonstrates the active participation of the applicant in each transaction.
I, the undersigned, certify the named applicant has accumulated a total of __________ points as indicated in the preceding
qualifying experience report. I further certify that the information given above is true to the best of my knowledge and belief. I
understand that any material misstatement made may result in the revocation or suspension of the license, if issued, as well as any
existing license of the applicant and/or the broker.
Broker Signature ________________________________________________________________ Date ________________________________
Broker Print Name_______________________________________________________________ UID# ________________________________
Additional Affirmations (if applicable)
I, the undersigned, certify the named applicant has accumulated a total of __________ points as indicated in the preceding
qualifying experience report. I further certify that the information given above is true to the best of my knowledge and belief. I
understand that any material misstatement made may result in the revocation or suspension of the license, if issued, as well as any
existing license of the applicant and/or the broker.
Broker Signature ________________________________________________________________ Date________________________________
Broker Print Name ______________________________________________________________ UID# ________________________________
Additional Affirmations (if applicable)
I, the undersigned, certify the named applicant has accumulated a total of __________ points as indicated in the preceding
qualifying experience report. I further certify that the information given above is true to the best of my knowledge and belief. I
understand that any material misstatement made may result in the revocation or suspension of the license, if issued, as well as any
existing license of the applicant and/or the broker.
Broker Signature ________________________________________________________________ Date ________________________________
Broker Print Name_______________________________________________________________ UID# ________________________________
DOS-0036-f-a (Rev. 08/19)
Page 8 of 12
B1
Real Estate Broker Application
Supplement B - Equivalent Experience in General Real Estate Business
Worksheet
Instructions for Completing Supplement B: You must accumulate a minimum of 5250 points* to qualify for a broker’s license based on
equivalent experience in general real estate business. Applicants must also possess at least 3 years of experience in the real estate business
equivalent to that of an active real estate salesperson*.
1. In the Number of Transactions Performed column, enter the amount of your activity for each category.
2. Multiply the number of transactions performed by the point value indicated to arrive at the points earned for that category.
3. Add the points earned for each category to arrive at your total points.
4. Enter the total figure on the Total Qualifying Points line. This is your final qualifying points earned.
*Except those using combined experience.
You must also complete the Employment History on the following page.
Number of Total
Point Transactions Points
Category Value X Performed = Earned
Residential Sales/Purchase:
1. Single Family, condo, co-op unit, multi family (2 to 8 unit), farm (with residence, under 100 acres) . . . 250 X =
2. Co-op unit transaction approved by seller and buyer that fails to win Board of Director’s approval . . . . 100 X =
Residential Rentals:
3. Rentals or subleases effected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 X =
4. Property Management - Lease renewal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 X =
- Rent collections per tenant/per year . . . . . . . . . . . . . . 1 X =
Commercial Sales:
5. Taxpayer/Storefront . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
6. Office Building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
7. Apartment Building (9 units or more) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
8. Shopping Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 400 X =
9. Factory/Industrial warehouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
10. Hotel/Motel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
11. Transient garage/parking lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
12. Multi-unit commercial condominium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
13. Urban commercial development site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
14. Alternative sale type transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
15. Single-tenant commercial condo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 X =
Commercial Leasing/ Financing (includes residential properties of more than four units)
16. New Lease - aggregate rental $1 to $200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 X =
17. New Lease - aggregate rental $200,000 to $1 million . . . . . . . . . . . . . . . . . . . . . 250 X =
18. New Lease - aggregate rental over $1 million . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
19. Renewal - aggregate rental $1 to $200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 X =
20. Renewal - aggregate rental $200,000 to $1 million . . . . . . . . . . . . . . . . . . . . . . . 125 X =
21. Renewal - aggregate rental over $1 million . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 X =
22. Financing - $1 to $500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 X =
23. Financing - $500,000 to $5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 X =
24. Financing - Over $5,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 X =
Miscellaneous:
25. Sale vacant lots, land (under 100 acres) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 X =
26. Sale vacant land (more than 100 acres) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 X =
27. Residential Financing - $1 to $500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 X =
Total Qualifying Points Claimed
DOS-0036-f-a (Rev. 08/19) Page 9 of 12
B2
Real Estate Broker Application
Supplement B - Equivalent Experience in General Real Estate Business
Employment History
You must indicate all employment which is commensurate with the experience claimed on the Equivalent Experience in General Real Estate
Business Worksheet. Begin with your most recent employment. Complete the appropriate box if you are claiming qualifying experience while
self-employed.
NAME OF COMPANY: DATES OF EMPLOYMENT: HOURS PER WEEK:
COMPANY ADDRESS: COMPANY TELEPHONE NUMBER: WERE YOU SELF EMPLOYED IN
THIS COMPANY?
YES NO
NAME OF COMPANY: DATES OF EMPLOYMENT: HOURS PER WEEK:
COMPANY ADDRESS: COMPANY TELEPHONE NUMBER: WERE YOU SELF EMPLOYED IN
THIS COMPANY?
YES NO
NAME OF COMPANY: DATES OF EMPLOYMENT: HOURS PER WEEK:
COMPANY ADDRESS: COMPANY TELEPHONE NUMBER: WERE YOU SELF EMPLOYED IN
THIS COMPANY?
YES NO
NAME OF COMPANY: DATES OF EMPLOYMENT: HOURS PER WEEK:
COMPANY ADDRESS: COMPANY TELEPHONE NUMBER: WERE YOU SELF EMPLOYED IN
THIS COMPANY?
YES NO
DOS-0036-f-a (Rev. 08/19) Page 10 of 12
C
Real Estate Broker Application
Supplement C - Combined Experience Worksheet
Combined Experience as a Licensed Real Estate Salesperson and Equivalent Experience in General Real Estate Business.
Instructions for completing Supplement C: You must accumulate a minimum of 5250 points to qualify for a broker’s license based on
combined experience in general real estate business and licensed real estate salesperson experience. Applicants must also possess at least
3 years of experience in the real estate business equivalent to that of an active real estate salesperson.
1. You must complete pages A1 and A2 of Supplement A for all licensed salesperson activity of less than 2 years. Please disregard the
minimum point requirement indicated in Supplement A.
2. You must complete pages B1 and B2 of Supplement B for all equivalent experience in general real estate business. Please disregard the
minimum point requirement indicated in Supplement B.
3. After completing Supplements A and B, utilize the following table for computing your total combined experience.
Enter in the box at right your qualifying points claimed on Supplement A.
Multiply by two. Enter this number in the box at the far right.
X 2
Enter in the box at right your qualifying points claimed on Supplement B.
Add your qualifying points claimed. This is your total qualifying points earned.
You must earn at least 5250 total points (from Supplement A and Supplement B) to qualify under combined experience. Please be sure
Supplement A and Supplement B are completely filled out.
IMPORTANT
(Please utilize the checklist on the next page to ensure you have included/completed all requirements.)
DOS-0036-f-a (Rev. 08/19) Page 11 of 12
Real Estate Broker Application
A COMPLETED APPLICATION MUST INCLUDE:
(Use this checklist to ensure you have included/completed all requirements.)
You must complete all required *responses.
If you do not complete all required responses, your application will be returned.
Page 3
You must check one of the five options for “I am applying based on the following qualification.”
Applicant Information:
Complete “Applicant Information” required (*) responses.
Non New York State Residents:
If you have a residence address outside NYS and do not possess a NYS DMV ID number: You must enter nine (9) zeroes for your
DMV ID number in the space provided as well as including a clear copy of a government issued photo ID (ex. Out of state driver
license or non-driver ID, US Passport, US Passport Card, etc).
Business Information:
Complete “Business Information” required (*) responses.
Business Name: Clearly print or type the business name under which you will conduct real estate business (as it appears on the filing
receipt or business certificate). Individual Broker applicants should complete this section with last, first and M.I. (if applicable).
o Business Address: All applicants MUST provide a business address.
Page 4
Broker License Type:
Indicate broker license type by selecting with an "X". (This section must correspond with the business name on Page 3).
Associate Broker applicants should not complete this section.
For Associate Broker Applicants only:
Your sponsoring broker must complete this section.
Page 5
If you answered YES to questions 1, 2 or 3:
Question #1 – court documentation which MUST be submitted: A copy of the certificate of disposition from the court AND
a copy of the accusatory instrument* from the court.
Question #2 – court documentation which MUST be submitted: A copy of the accusatory instrument* from the court AND
adjournment notice(s) indicating future court date(s) from the court.
Question #3 – you must provide all relevant documents, including the agency determination, (if any).
*An accusatory instrument is a document that is used by prosecutors and the criminal courts to charge and prosecute someone accused of a crime(s) and
details the facts and circumstances surrounding the crime(s).This could be an Indictment, Superior Court Information, Criminal Complaint, etc.
Child Support Statement: (Please read Applicant Affirmation on Page 5)
Applicant Affirmation: Please print and sign your name and date the application.
STOP here if you are applying for an additional broker license, reciprocal broker license or if you are an attorney admitted to the NYS
Bar Association.
Page 6 Education: These sections must be completed by the School Coordinator OR you may submit copies of your course certificates.
Pages 7 and 8
Licensed Salesperson Activity Worksheet: must be completed and calculated for total qualifying points claimed.
Licensed Salesperson Employment History: complete the salesperson employment history. The principal broker(s) that sponsored
you during the time period that you accrued the points claimed from page A1 must write the points and sign and date the affirmation.
Pages 9 and 10
Equivalent Experience in General Real Estate Business Worksheet: must be completed and calculated for total qualifying points
claimed.
Employment History: complete the employment history.
Pag
e 11 Combined Experience – complete this section ONLY if claiming combined experience.
Application fee: $155.00 payable to the NYS Department of State. (see instructions for acceptable payment
methods).
DOS-0036-f-a (Rev. 08/19)
Page 12 of 12
Become an Organ and Tissue Donor
Organ donors save lives. If you would like to be an organ and tissue donor upon your death, you may enroll in the
NYS Donate Life Registry online at www.donatelife.ny.gov/register or complete the form below. Completed forms
should be sent to the NYS Donate Life Registry by email --- Registry@donatelife.ny.gov or, mail - NYS Donate Life
Registry, 185 Jordon Road, Troy, NY 12180.
Fields with an asterisk (*) are required for enrollment. Upon receipt of your completed enrollment form, you will be
sent an email or letter confirming your enrollment and providing you with information on how to limit your donation.
I understand that by opting out of enrolling in the NYS Donate Life Registry, or skipping this question, will not impact
or impair my ability to obtain services from the New York Department of State, Division of Licensing Services.
*Last name
*First name
Middle Initial Suffix
*Address
*Apt. Number *Zip Code
*City
*Birth date / / *Gender M
F
MM DD YYYY
Email address
DMV or IDNYC Number
By sign
ing below, you certify that you are:
• 16
years of age or
older;
• Consent
ing to donate your organs and tissues fo
r
transplant
ation and/or research in the event of your de
ath;
• Auth
orizing the New York Department of State, Division
of
Licen
sing Services to transfer your name and identifyin
g
information to the NYS Donate Life Registry for
enrollment;
and
• Authorizing the Registry to give access to this information
to federa
lly regulated organ procurement organization
s
and NYS-lice
nsed tissue and eye banks and others
approved by the NYS Commissioner of Health in
the event
of your death.
*Sign *Date
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Real Estate Broker Application Instructions (New York State)

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Completed 27 October 2020

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