ILLINOIS REGISTER 6165
09
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
NOTICE OF PROPOSED AMENDMENTS
8. Present or proposed position with the applicant entity.
9. List complete employment record for the past 20 years, whether compensated or
otherwise (up to and including present jobs, positions, partnerships, owner of an entity,
administrator, manager, operator, directorates or officerships). Please list the most recent
first. Attach additional pages if the space provided is insufficient. It is only necessary to
provide telephone numbers and supervisory information for the past 10 years.
Beginning/Ending
Dates (MM/YY)
-
Employer's Name
Address City State/Province
Country Postal Code Phone
Offices/Positions Held
Supervisor/Contact
Beginning/Ending
Dates (MM/YY)
-
Employer's Name
Address City State/Province
Country Postal Code Phone
Offices/Positions Held
Supervisor/Contact
Beginning/Ending
Dates (MM/YY)
-
Employer's Name
Address City State/Province
Country Postal Code Phone
Offices/Positions Held
Supervisor/Contact
Beginning/Ending
Dates (MM/YY)
-
Employer's Name
Address City State/Province
