The goalkeeper started his career with VfL Husen 19 and SuS Kaiserau.
Then he left for Westfalia Herne. While there he played 18 times for the Germany national football team. His next team was Borussia Dortmund. From 1963 to 1967 he played 81 times in the German Bundesliga for Dortmund as well as 21 times for the German National Football Team.
His career ended playing for Eintracht Frankfurt (40 games in the Bundesliga).
Tilkowski won the German Cup with Dortmund 1965 and the European Cup of National Cup-Winners in 1966.
He was honoured as German player of the year in 1965.
Tilkowski was a member of the World Cup teams of 1962 and 1966. In 1962 he was only the backup-keeper. Coach Herberger took the young Wolfgang Fahrian as number one.
In 1966 Tilkowski was a member of the German team which lost the World Cup Final against England. He later took up coaching, taking charge of 1. FC Nuremberg, Werder Bremen and 1. FC Saarbrücken.