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F1345L&T Indd Form
Profession Code 129 - Complete the remainder of this form. RETURN THE COMPLETED FORM TO THE APPLICANT IN A SEALED ENVELOPE. PART I - EMPLOYMENT INFORMATION A. Verification must be completed by each employer therefore you are authorized to photocopy this form if necessary. SUPPORTING DOCUMENT IMPORTANT NOTICE Completion of this form is necessary for consideration for licensure under 225 ILCS 446/1 et. APPLICANT JOB TITLE C. TIME IN TITLE Years Months D. TYPE OF EMPLOYMENT E. ANNUAL HOURS...
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