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PLEASE TYPE OR PRINT IN BLACK INK ONLY. IMPORTANT NOTICE: Completion of this form is necessary to accomplish the requirements outlined in 225 ILLS 60×1 ET. seq. (Illinois Compiled Statutes×. Disclosure
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How to Fill Out Affidavit of Licensure:

01
Begin by obtaining the necessary affidavit of licensure form. This form is usually provided by the licensing board or regulatory agency that oversees your profession or industry. You may be able to download the form from their official website or request a copy through mail or in-person.
02
Carefully read the instructions provided with the affidavit of licensure form. These instructions will guide you through the specific requirements and information that need to be provided on the form.
03
Start by entering your personal information on the affidavit of licensure form. This typically includes your full name, contact details, license number, and any other identification information required.
04
Next, provide details about your professional qualifications and relevant licensure. This may include information such as the date you obtained your license, the licensing authority or board that issued it, and any specialty areas or endorsement you hold.
05
If applicable, disclose any disciplinary actions, investigations, or pending complaints against your license. Be sure to follow the instructions provided on the form for reporting such information accurately and comprehensively.
06
Review the completed affidavit of licensure form for accuracy and completeness. Double-check that all the required fields have been filled out and that the information provided is correct and up-to-date.
07
Sign and date the affidavit of licensure form. Make sure to sign using your legal signature and include the date of signing.

Who Needs Affidavit of Licensure?

01
Individuals applying for certain jobs or positions that require a professional license, certification, or registration may be required to submit an affidavit of licensure. This ensures that the applicant meets the necessary qualifications and has the required licensing or certification for the specific role.
02
Licensed professionals who are applying for a license in another jurisdiction or state may need to submit an affidavit of licensure as part of the application process. This verifies their existing licensure and allows for reciprocity or transfer of their license.
03
Individuals facing disciplinary actions or investigations related to their professional license may be required to submit an affidavit of licensure to provide information about their case and any relevant details.
Remember to always check with the specific licensing board or regulatory agency to determine if an affidavit of licensure is required for your situation and to obtain the most up-to-date form and instructions.
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Baffidavitb of licensure is a legal document that certifies an individual's licensing status.
Individuals who hold professional licenses or certifications are required to file baffidavitb of licensure.
Baffidavitb of licensure can be filled out by providing personal information, license details, and signing the document.
The purpose of baffidavitb of licensure is to verify and confirm an individual's licensing status.
Information such as name, license number, expiration date, and any disciplinary actions must be reported on baffidavitb of licensure.
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Illinois LICENSURE IDFPR seq ILCS IL486-2096 AFFIANT CERTIFYING encumbered licensing SUBSCRIBED utilized Certification herein ACKNOWLEDGEMENT notarized Compiled APPLICANT Statutes NOTARY outlined unsuccessful penalties Disclosure Completion solemnly requi

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