CERTIFICATION
NAME OF APPLICANT
NAME OF RESPONSIBLE BROKER
AFFILIATION DATE (MONTH/DAY/YEAR) WORKING STATUS NO. OF HOURS PER WEEK (REQUIRED)
(FROM) (TO)
APPLICANT'S LICENSED REAL ESTATE ACTIVITY CONSISTED OF: (ATTACH EXTRA SHEETS IF NECESSARY - ATTACHMENTS MUST BE SIGNED BY CERTIFIER)
HOW ARE YOU AWARE OF THE APPLICANT'S EXPERIENCE:
GENERAL INFORMATION
• This form is to be completed and submitted in conjunction
with the Licensed Experience Verication (RE 226) only
when it is absolutely impossible to secure certications
from former responsible brokers.
• Type or print clearly ink.
• Complete all information below.
• Do not submit photocopies of the completed form.
• The applicant must complete the RE 226 in full. The
reason the broker's signature could not obtained must
be indicated in the space labeled “Signature of Certifying
Broker” (i.e., deceased, litigation, etc.).
• Two Experience Certication (RE 228) forms are required
with each RE 226 submitted.
• The experience information on both RE 228’s and the
RE 226 must contain identical information for proper
certication.
• 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.
EXPERIENCE INFORMATION
FULL TIME PART TIME
SIGNATURE OF VERIFIER DATE
@
PRINTED/TYPED NAME OF VERIFIER TITLE OF VERIFIER, IF APPROPRIATE
BUSINESS ADDRESS BUSINESS TELEPHONE NUMBER
( )
I hereby certify that the above experience information is correct to the best of my knowledge.
Experience Certification
