License Examination Application
License Examination Application Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: License Examination Application, COM 3578, Ohio Statewide, Department Of Commerce
Please visit our website at www.com.ohio.gov/real 614 | 466-4100 Fax 614 | 644-0584 TTY/TDD: 800 | 750-0750 LICENSE EXAMINATION APPLICATION BROKER This form is interactive. Type the required information into the form, print, sign, date, FEE: $100.00 and forward to the Division for processing. Otherwise, the form may be printed, typed or FOR DIVISION USE ONLY handwritten (legibly to prevent delays in processing, black ink). Note: Incomplete FILE NUMBER applications will be returned to the requestor for correction. A check or money order for $100.00 made payable to: Division of Real Estate & Professional Licensing, must be remitted with this form. Cash will not be accepted. Attach a copy of the transcript/certificate of required pre-licensure education. Attach a statement describing any real estate experience other than sales/leasing. If you were originally licensed on or after January 3, 1984, you must also attach proof that you have satisfactorily completed a minimum of two years of post secondary education. The pre-licensure requirements may be included in these two years. Note: The name and date of birth on this application must match the name and date of birth on the government issued photo identification you will use to identify yourself at the examination site. APPLICANT INFORMATION FIRST NAME MIDDLE NAME HOME ADDRESS LAST NAME SUFFIX HOME PHONE ( CITY STATE SOCIAL SECURITY NUMBER ) ZIP CODE + 4 COUNTY DATE OF BIRTH (mm/dd/yyyy) EMAIL ADDRESS FILE NUMBER (if currently licensed) ORIGINAL LICENSURE DATE DATE OF LAST BROKER EXAMINATION (if no license was issued) ETHICAL CONDUCT AND LEGAL HISTORY PLEASE ATTACH A COMPLETE EXPLANATION FOR ANY QUESTIONS ANSWERED “YES” BELOW. QUESTIONS CONCERNING PROFESSIONAL LICENSES APPLY TO ALL PROFESSIONAL LICENSES REGARDLESS OF PROFESSION. YES NO Have you ever been disciplined in any manner by any public entity or professional or trade association for any violation of any professional licensing law, regulation or ethical rule? YES NO Have you ever been refused or denied any professional license or registration by any public entity? YES NO Have you ever had any professional license revoked, suspended or limited in any way for any reason? YES NO Have you ever been notified by any public entity or professional or trade association that you were under investigation for any violation of any professional licensing law, regulation or ethical rule? YES NO Have you ever been the subject of any unsatisfied judgments? YES NO Have you ever been convicted of, plead guilty to or been granted intervention in lieu of conviction for any unlawful conduct excluding minor traffic violations? EXPLAIN: ______________________________________ THE APPLICANT MUST COMPLETE THE FOLLOWING CERTIFICATION I certify that all of the statements on this application and all of the attached materials are complete and accurate. I understand that any false statement on this form or the attached materials may subject me to criminal prosecution and the loss of my Ohio real estate license. ___________________________________ _______________ SIGNATURE OF APPLICANT DATE NOTICE: Per R.C. Section 149.43, this application and the information contained therein, except for the social security number, is public record. NOTICE: Per R.C. Section 4735.06(B), if an application is denied prior to the applicant’s being admitted to the examination, the division, to cover the expenses of processing the application, shall retain one-half of the fees and the other one-half shall be returned to the applicant. NOTICE: Evidence that payment has been refused by the drawer's bank upon a check drawn to the order of the Ohio division of real estate shall constitute prima facie evidence of misconduct and shall constitute a violation of section 4735.18(A)(6) of the Revised Code. COM 3578 (Rev. 02/2010) Page 1 of 2 “An Equal Opportunity Employer and Service Provider” American LegalNet, Inc. www.FormsWorkFlow.com EDUCATION Requirements for an Ohio Broker’s License: 1. Applicant must take four pre-licensure courses in a classroom setting at an institution of higher education: • Ohio Real Estate Law (40 hours) • Real Estate Principles & Practices (40 hours) • Real Estate Appraisal (20 hours) • Real Estate Finance (20 hours) 2. Applicant must possess a minimum of two years of post-secondary education, or a total of sixty (60) semester hours or ninety (90) quarter hours from an accredited college or university. 3. Take the following four required courses at an accredited college or university. These courses may be included in the post-secondary education: • A Financial Management course • A Human Resources or Personal Management course • An Applied Business Economics course • A Business Law course **ATTACH A COPY OF THE OFFICIAL TRANSCRIPT OR CERTIFICATES OF COMPLETION FOR THE ABOVE COURSEWORK.** EXPERIENCE To be eligible for the Ohio Real Estate Broker Examination, the applicant must have been licensed as a real estate broker or salesperson for two of the last five years and must have worked as a licensed real estate broker or salesperson for an average of thirty (30) hours per week for two of the last five years. YES NO Have you been a licensed real estate broker or salesperson and worked as such an average of thirty (30) hours per week for two of the last five years? TRANSACTIONS Ohio Administrative Code 1301:5-3-04 (A) For the purposes of division (B)(5)(a) of section 4735.07 of the Revised Code, “real estate transaction” shall be defined as follows: (1) One consummated bona fide sale of a real property and the improvements thereon for the account of another, in which the applicant received compensation and was the procuring or selling agent, shall constitute one-half transaction. (2) One consummated bona fide sale of a real property and the improvements thereon for the account of another, in which the applicant received compensation and was the listing agent, shall constitute one-half transaction. (3) One lease of individual commercial or industrial property for a term of at least one year, for the account of another, in which the applicant received compensation and was the procuring agent, shall constitute one-half transaction. (4) One lease of individual commercial or industrial property for a term of at least one year for the account of another, in which the applicant received compensation and was the listing agent, shall constitute one-half transaction. (5) Four leases of residential property for a term of at least one year for the account of another, in which the applicant received compensation and was the listing and/or procuring agent, shall constitute one transaction. Indicate the real number of real estate transactions that you were involved in as a real estate licensee and multiply by the indicated transaction value to arrive at the total number. For example, seven (7) transactions in which you were the listing agent multiplied by 0.5 equals 3.5 total transactions. Add the transactions to arrive at the total number of transactions. The total transactions must equal twenty (20) or more. SALES: SALES IN WHICH APPLICANT WAS THE SELLING/PROCURING AGENT X 0.5 = SALES IN WHICH APPLICANT WAS THE LISTING AGENT X 0.5 = ONE-YEAR LEASES: COMMERCIAL X 0.5 = RESIDENTIAL X 0.25 = TOTAL TRANSACTIONS (Must total 20 or more transactions) BROKER INFORMATION: List each broker, including complete current address, for whom you have worked for as a sales agent. This information will be used to solicit affidavits to verify completion of the required transactions. Each broker will be requested to return the affidavit within fourteen business days. Attach additional pages as needed. BROKER LICENSE NUMBER BROKER NAME PHONE NUMBER ( ADDRESS BROKER LICENSE NUMBER BROKER NAME STATE ADDRESS BROKER NAME STATE ) CITY BROKER NAME STATE ZIP CODE PHONE NUMBER ( ADDRESS ZIP CODE PHONE NUMBER ( BROKER LICENSE NUMBER ) CITY ADDRESS ZIP CODE PHONE NUMBER ( BROKER LICENSE NUMBER ) CITY CITY ) STATE ZIP CODE Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com