Get Pdf Version - Illinois Department Of Professional Regulation

Completing the PDF Version - Illinois Department Of Professional Regulation requires careful attention to detail to ensure compliance with state regulations. This guide will provide you with clear and supportive instructions on how to effectively fill out the form online.

Follow the steps to complete your form accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it in the designated PDF editor.
2. Begin by entering the name of the firm making the application in the first field.
3. In the second field, provide the firm’s federal employee identification number.
4. Fill in the complete address of the firm, including the street address, city, state, and zip code.
5. Enter the date and place of birth for the director, officer, or shareholder associated with the firm.
6. Indicate whether the individual is an officer, director, partner, or employee of the firm by selecting 'Yes' or 'No'.
7. Provide the name of the director, officer, or shareholder in the next field.
8. Complete the residence address for the individual listed above, ensuring to include street, city, state, and zip code.
9. Select the appropriate title from the list provided, including president, vice president, secretary, director, treasurer, or other.
10. Detail the record of previous occupations for the past five years, including names and addresses of businesses and relevant dates.
11. Answer the questions related to licensing, indicating if the license has ever been revoked or suspended in any state.
12. Indicate if you have an interest in the applicant and provide details on the extent and nature of this interest.
13. Describe any written agreements regarding the acquisition of additional interest, if applicable.
14. Outline any compensation arrangements with the organization, attaching a separate sheet if needed.
15. List any affiliated companies, specifying your relationship to each.
16. Respond to all questions regarding prior bankruptcies, criminal history, or injunctions, providing explanations on separate sheets when necessary.
17. Finally, review the information for accuracy, sign the form, and ensure it is notarized.
18. After completing all sections, save your changes, and download, print, or share the document as required.

Take the next step towards compliance and efficiently complete your documents online.