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Verification of Self-Employment Form - Illinois.gov 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your full name in the designated field for 'Full Name of Applicant/Resident'.
  3. Fill in your current address, including street, city, state, and zip code.
  4. In the income section, certify your earnings by writing your name and total amount received for the specified work.
  5. Indicate your expected earnings for the next twelve months along with the starting and ending dates of this work.
  6. Sign and date the form at the bottom where indicated. Ensure that you also have a notary public sign if required.

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