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Work Permit Application Kit

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Each year more than 90,000 immigrant workers come to Canada ontemporary work permits. Their presence in the labour market helpsCanadian companies to fill the jobs where there are still skill shortages. Anyforeign worker who wishes to come to Canada to work on a temporary basismust obtain a work permit first.

This kit is a guide for anyone who wishes to work in Canada on a temporaryWork Permit. It has been designed to help applicants fill out the TemporaryWork Permit application.

In this kit you will find: Information on the Temporary Work Permit All the forms that must be completed along with step-by-step

instructions List of required supporting documentation How to pay your fees Where to submit your application Where to get a police clearance and medical examination Sample application reviewed by a licensed Canadian immigration

professional

HOW TO USE THIS KIT:Step 1: Read the instructions and review the sample form provided to you.Step 2: Fill out the application forms for a Temporary Work PermitStep 3: Submit your application form with supporting documents and fee


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INDEX

About the Temporary Work Permit 3Open Work Visas for immediate family members 4Qualifying for a Temporary Work Permit 5

Applying from a country other than Canada Applying from Canada Entering Canada

Details of jobs where no work visa is required 7Getting a medical examination 8Getting police clearance 16How to complete your application 17Photo Specifications 19How to pay the fees 20Where to submit your application 21Conditions on the Temporary Work Permit 23

AppendixApplication forms


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Temporary Work Permit

To apply for a Temporary Work Permit, you must first find a temporary jobin Canada. There are many job sites on the internet offering such workbecause Canada has a shortage of labour in some areas. If the employeroffering the vacancy is satisfied with your application, he / she will makeyou an offer.

Once you have received your job offer your new Canadian employer needsto determine if you are eligible to work in Canada on a Temporary WorkPermit. Your employer needs to obtain confirmation from HumanResources and Social Development Canada (HRSDC)http://www.hrsdc.gc.ca/eng/home.shtml as to whether the position offeredcan be filled by an immigrant worker rather than a Canadian citizen orpermanent resident. This is the responsibility of the company employingyou – some jobs do not need HRSDC clearance, but many do.

Each applicant needs to fulfill the requirements for entering Canada as wellas those needed to obtain a temporary work permit. In some instances youmay need to obtain a temporary resident visa. You can find out more aboutthis by clicking on this linkhttp://www.cic.gc.ca/ENGLISH/information/applications/visa.asp

Your temporary work permit will not allow you to live in Canada on apermanent basis; only live-in caregivers can stay permanently if they meetthe immigration requirements. You can however bring your immediatefamily (spouse, common-law partner and dependent children) to Canadawith you but they must apply for a temporary resident visa.

http://www.hrsdc.gc.ca/eng/home.shtml

http://www.cic.gc.ca/ENGLISH/information/applications/visa.asp


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Open Work Visas for Immediate Family Members

Your spouse, common-law partner and older children may also be able towork in Canada under you’re an Open Work Permit, which will allow themto work with any employer in any job without the employer having to obtainclearance from Human Resources and Social Development Canada. Somejobs however will require a medical certificate or a professional licence. Theopen work permit will only be valid for the duration of your TemporaryWork Permit. Your dependants will only be able to get an Open WorkPermit if your Temporary Work Visa lasts for a minimum of 6 months andyour work in Canada is of a particular skill level. Dependents who wish towork in Canada should apply for an Open Work Visa at the same time asyou submit your application for a Temporary Work Permit. Work permitsare only issued to dependent children on a trial basis and in Ontario andAlberta.


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Qualifying for a Temporary Work Permit

It is easier to apply for your Temporary Work Permit when you are livingoutside of Canada. To be eligible for a temporary work permit you musthave an offer of employment from a company in Canada. Your newemployer must also provide you with written authorization known as a‘positive labour market opinion’ from Human Resources and SkillsDevelopment Canada that the vacancy he / she has offered can be filled by aforeign worker. Some positions do not require confirmation from theHRSDC. They include the following positions:

Work covered under an international agreement e.g. investment Personnel transfers between companies Jobs through exchange programmes where a Canadian will work in

the country of the foreign worker Co-op Students who need to work in Canada as part of their course of

study Academics and Students Religious Workers Military Personnel Performing Artists

You can check which jobs do not require a work permit by clicking this linkhttp://www.cic.gc.ca/english/work/apply-who-nopermit.asp

Immigration officers in Canada need to be sure that you will leave thecountry once your visa has expired. You must prove that your finances aresufficient to support yourself and any dependents during your stay inCanada. If you are applying for a Temporary Work Permit extending over 6months you may be required to apply for a temporary resident visa at thesame time as applying for a Temporary Work Permit. Click this link to see ifyou need a temporary resident visahttp://www.cic.gc.ca/english/visit/visas.asp

http://www.cic.gc.ca/english/work/apply-who-nopermit.asp

http://www.cic.gc.ca/english/visit/visas.asp


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You can apply for a Temporary Work Permit from inside of Canada only ifyou want to change jobs and already have a work permit or if you are adependent who came to Canada as part of a family member TemporaryWork Permit. If you have obtained a temporary resident permit that lastsfor 6 months or longer or you are applying for permanent residence you canalso apply for a work permit from within Canada.

Another way to get a Temporary Work Permit is to apply at the border whenyou enter the country, however this is only possible if you already have atemporary resident visa or if you have a job offer and a market opinion fromHuman Resources and Skills Development Canada or if the job you havebeen offered belongs to the above list of posts not requiring a work visa.


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Jobs Where No Labour Market Opinion is Required

If your job falls under one of the following categories, your Canadianemployer does not have to produce a labour market opinion document fromHuman Resources and Skills Development Canada (HRSDC) but you stillneed to get a work permit to reside and work legally in Canada.

Workers covered under international agreementsThis category includes business people who want to conduct business inCanada under an international agreement along with traders, investors andprofessionals.

Entrepreneurs and intra-company transfereesThis category includes any workers transferring from one branch of acompany located outside of Canada to another branch of the companylocated in Canada. It also includes work, conducted by some entrepreneursand workers, which will provide a noteworthy benefit to Canadian citizensand permanent residents.

Participants in exchange programsThis category includes workers who are part of a foreign work exchangeprogramme, which provides reciprocal work for Canadian citizens abroad.An example of an exchange programme is a teacher exchange.

Co-op studentsThis category includes foreign students who need to do work placement inCanada as part of their course of study.

Spouses and common-law partnersThis category consists of the spouses and common-law partners of workersin certain job categories.

Religious workersThis category includes people involved in charity or religious posts.


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Getting Medical Clearance

If you are applying for a Temporary Work Permit that extends over 6months and you come from or have lived in one of the following countriesduring the last year (for 6 continuous months) you must obtain medicalclearance at a medical office listed in one of the cities below.

Country/TerritoryMedical

Office

Afghanistan New Delhi

Algeria Paris

Angola Nairobi

Argentina Port of Spain

Armenia London

Ascension Paris

Azerbaijan London

Azores Paris

Bahamas Port of Spain

Bahrain London

Bangladesh Singapore

Belarus London

Belau – Republic of Beijing

Belize Port of Spain

Benin Paris

Bhutan New Delhi

Bolivia Port of Spain

Bora Bora Singapore

Bosnia-Hercegovina Vienna


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Botswana Nairobi

Brazil Port of Spain

Brunei Singapore

Bulgaria Vienna

Burkina-Faso Paris

Burundi Nairobi

Cambodia Singapore

Cameroon Paris

Cap Vert Paris

Central African Rep. Paris

Chad Paris

Chagos Archipelago Nairobi

China Beijing

Colombia Port of Spain

Comoros – Islamic Federal Republic Nairobi

Congo – Democratic Republic (Kinshasa) Paris

Congo – Republic (Brazaville) Paris

Croatia Vienna

Djibouti Nairobi

Dominican Republic Port of Spain

Ecuador Port of Spain

El Salvador Port of Spain

Equatorial Guinea Paris

Eritrea Nairobi

Estonia London

Ethiopia Nairobi

French Guiana Port of Spain


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Gabon Republic Paris

Gambia Paris

Georgia London

Ghana Paris

Guam Manila

Guatemala Port of Spain

Guinea – Republic of Paris

Guinea-Bissau Paris

Guyana Port of Spain

Haiti Port of Spain

Honduras Port of Spain

Hong Kong Beijing

Huahine Singapore

India New Delhi

Indonesia Singapore

Iran Paris

Iraq Paris

Island – Christmas Singapore

Island – Easter Port of Spain

Island – Truk Manila

Island – Wake Manila

Island – Yap Manila

Islands – Admiralty Singapore

Islands – Austral Singapore

Islands – Balearic Paris

Islands – Canary Paris

Islands – Cooz Singapore


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Islands – Gambier Singapore

Islands – Kerguelen Nairobi

Islands – Loyalty Singapore

Islands – Marquesas Singapore

Islands – Marshall Manila

Islands – Midway Manila

Islands – New Guinea Singapore

Islands – Solomon Singapore

Islands – U.S. Trust Terr. of Pacific Manila

Ivory Coast Paris

Johnston Atoll Manila

Kazakhstan London

Kenya Nairobi

Kiribati Singapore

Korea (North) Manila

Korea (South) Manila

Kosovo Vienna

Kosrae Beijing

Kyrgyzstan London

Laos Singapore

Latvia London

Lesotho Nairobi

Liberia Paris

Libya Paris

Lithuania London

Macao Beijing

Macedonia Vienna


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Madagascar Nairobi

Madeira Paris

Maio Singapore

Makatea Singapore

Malawi Nairobi

Malaysia Singapore

Maldives Singapore

Mali Republic Paris

Maupiti Singapore

Mauritania Paris

Mauritius Nairobi

Mexico Port of Spain

Micronesia Manila

Moldova Vienna

Mongolian People’s Republic Beijing

Montenegro Vienna

Moorea Singapore

Morocco Paris

Mozambique Nairobi

Myanmar – Union of Singapore

Namibia Nairobi

Nepal New Delhi

New Britain Singapore

New Caledonia Singapore

New Guinea Mainland Singapore

New Hebrides Singapore

New Ireland Singapore


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Nicaragua Port of Spain

Niger Paris

Nigeria Paris

Northern Mariana Manila

Northern Sinai Paris

Oman London

Pakistan New Delhi

Palau Manila

Panama Port of Spain

Papua New Guinea Singapore

Paraguay Port of Spain

Peru Port of Spain

Philippines Manila

Ponape Manila

Portugal Paris

Qatar London

Raiatea Singapore

Reunion Nairobi

Romania Vienna

Russia London

Rwanda Nairobi

Sabah Singapore

Saharawi Arab Democratic Rep. Paris

Sao Tome e Principe Paris

Sarawak Singapore

Saudi Arabia London

Senegal Paris


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Serbia Vienna

Seychelles Nairobi

Sierra Leone Paris

Singapore Singapore

Society Archipelago Singapore

Somali Republic Nairobi

South Africa – Rep. of Nairobi

Sri Lanka Singapore

St. Helena Paris

Sudan London

Surinam Port of Spain

Swaziland Nairobi

Syria Paris

Tahaa Singapore

Tahiti Singapore

Taiwan Singapore

Tajikistan London

Tanzania Nairobi

Thailand Singapore

Tibet Beijing

Togo Paris

Tristan Da Cunha Paris

Tuamotu Archipelago Singapore

Turkmenistan London

Uganda Nairobi

Ukraine Vienna

Uzbekistan London


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Vanuatu Singapore

Venezuela Port of Spain

Vietnam Singapore

West Bank/Gaza Paris

Western Sahara Paris

Yemen London

Zambia Nairobi

Zimbabwe Nairobi

Click the link to find out of the country you are coming from requires thatyou have a medicalhttp://www.cic.gc.ca/english/information/medical/dcl.asp.

http://www.cic.gc.ca/english/information/medical/dcl.asp


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Getting Police Clearance

You must also have a clean criminal record and prove that you are not a riskto national security – you may have to provide a police certificate provingthis. A clean police certificate shows that you do not have a criminal record.Police certificates vary in name and style from country to country. Anyoneapplying for a visa to Canada along with any dependents over 18 years ofage need police clearance before applying for a visa to Canada. You mustapply to the police or government body in the country where you have livedfor the past six months prior to making your application for a Canada visa.The police certificate should be attached to your visa application and mustnot be more than three months old. If the certificate is written in a languageother than English or French you must also obtain a translation (intoEnglish or French) from an official translator.

The official body responsible for issuing your police certificate may requireyou to provide previous addresses, fingerprints, photographs or otherinformation as well as paying a fee.Canada Citizenship and Immigration also perform checks on your criminalrecord with the countries you and your adult dependents have lived in.

Click on this link to find out how to obtain a police certificate in the countrywhere you live http://www.cic.gc.ca/english/information/security/police-cert/index.asp.

http://www.cic.gc.ca/english/information/security/police-


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Filling Out Your Application for a Work Permit

This kit contains the following application forms:

IMM 1295 Application for a Work Permit for use by the principalapplicant

IMM 5488 Document Checklist for use by the principal applicant

IMM 5409 Statuary Declaration of Common-Law Union to be filledout by you the principal applicant and your partner if you are not married

IMM 5476 Use of a Representative if you are using somebody torepresent your application like an immigration agency you need to fill outthis form

1. You must fill out the application form by printing all names in full asthey appear on your passport.

2. Fill in your current mailing3. Fill in your residential addresses or that of a representative if you are

using one.4. Add in your exact date of birth.5. Add your place of birth and include the city or town, the state or

province and the country.6. Enter the names of the countries of which you are a legal citizen.7. Fill out your gender.8. Place an X in the relevant box that describes your marital status.9. Print the personal details of any dependents including their exact

names from their passports, their date of birth, their relationship withyou the principal applicant

10. Leave this space blank.11. Give details of your current job.12.Detail the length of time in your current job.13.Provide the name and address of your current employer.


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14.Give the name and address of the company who will employ you inCanada.

15.Give the title of your job in Canada and a brief description of the workyou will perform there.

16.State how much you will earn in your job in Canada in Canadiandollars.

17.List the date your job in Canada will start.18. List the date that your employment ends.

19. Detail any medical conditions you or your family members have anddetails of any criminal convictions.20 & 21.List any countries other than the one of permanent residencewhere you have lived in the last five years for more than six months.

22. Sign the application


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Photo Specification Guide

Your application could be delayed if the guide is not followed.• Provide two identical photographs taken within the last six months. Theymay be either black and white or colour.• The photos must be clear, well defined and taken against a plain white orlight-colored background.• If the photos are digital, they must not be altered in any way.• Your face must be square to the camera with a neutral expression. Do notfrownor smile. Keep your mouth closed.• You may wear prescription glasses as long as your eyes are clearly visible.Sunglasses are not acceptable.• A hairpiece or other cosmetic accessory is acceptable if it does not disguiseyour normal appearance.• If you must wear a head covering for religious reasons, make sure your fullfacial features are visible.

The photos must show the full front view of the head, with the face in themiddle of the photo, and include the top of the shoulders.The size of the head, from chin to crown, must be between 31 mm (1 1/4")and 36 mm (1 7/16").

Crown means the top of the head or where the top of the head would be if it could be seen.


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How to Your Pay Application Fees

If you are applying for a Temporary Work Visa and are based in Canadaalready you can pay your application fee into a bank or via Western Unionor you can pay by credit card online. If you make your payment online youwill need to download Adobe® Acrobat Reader. If you do pay online youmust print off the receipt provided after payment and include it with yourapplication form. To pay online click here:https://services3.cic.gc.ca/epayweb/LineOfBusiness.do

If you are applying for your Temporary Work Visa from outside of Canadayour application fee must be submitted at the same time as your applicationto the relevant consulate, Embassy or High Commission. Addresses can befound by clicking this link http://www.international.gc.ca/ciw-cdm/embassies-ambassades.aspx?lang=eng

The fee for a temporary work permit is CDN $150 per person.

http://www.international.gc.ca/ciw-


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Where to Submit the Application

Submit your application to a Citizenship and Immigration Canada (CIC)office in the country where you live. You can find addresses by clicking thislink http://www.cic.gc.ca/english/information/offices/index.asp

If you are applying from within Canada, this link will also provide you withthe addresses for visa offices in Canada.

You must submit the application at the visa office that has jurisdiction overthe area where you live. The following visa offices accept Temporary WorkPermit applications:

Asia and Pacific

Australia (Sydney)Bangladesh (Dhaka)China (Beijing – Hong Kong –Shanghai)India (Chandigarh – New Delhi)Indonesia (Jakarta)Japan (Tokyo)Korea (Seoul)Malaysia (Kuala Lumpur)Pakistan (Islamabad)Philippines (Manila)Singapore (Singapore)Sri Lanka (Colombo)Taiwan (Taipei)Thailand (Bangkok)Vietnam (Ho Chi Minh City)

Europe

Austria (Vienna)France (Paris)Germany (Berlin)Italy (Rome)Poland (Warsaw)Romania (Bucharest)Russia (Moscow)Serbia (Belgrade)Turkey (Ankara)Ukraine (Kyiv)United Kingdom (London)

Africa and Middle East

Algeria (Algiers)

Western Hemisphere

Argentina (Buenos Aires)

http://www.cic.gc.ca/english/information/offices/index.asp


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Burkina Faso (Ouagadougou)Cameroon (Yaounde)Congo (Kinshasa)Egypt (Cairo)Eritrea (Asmara)Ethiopia (Addis Ababa)Ghana (Accra)Iran (Tehran)Israel (Tel Aviv)Ivory Coast (Abidjan)Jordan (Amman)Kenya (Nairobi)Lebanon (Beirut)Madagascar (Antananarivo)Mali (Bamako)Morocco (Rabat)Nigeria (Lagos)Rwanda (Kigali)Saudi Arabia (Riyadh)Senegal (Dakar)South Africa (Pretoria)Syria (Damascus)Tanzania (Dar-es-Salaam)Tunisia (Tunis)Uganda (Kampala)United Arab Emirates (AbuDhabi)Zimbabwe (Harare)

Brazil (Sao Paulo)Chile (Santiago)Colombia (Bogota)Costa Rica (San José)Cuba (Havana)Dominican Republic (SantoDomingo)Ecuador (Quito)El Salvador (San Salvador)Guatemala (Guatemala City)Guyana (Georgetown)Haiti (Port-au-Prince)Jamaica (Kingston)Mexico (Mexico City)Peru (Lima)Trinidad and Tobago (Port ofSpain)United States (Buffalo – Detroit –Los Angeles – New York – Seattle –Washington, D.C.)Venezuela (Caracas)


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Conditions Of the Temporary Work Permit

When you arrive in Canada you must show your letter of authorization towork here, which was sent to you by the visa processing unit in the countrywhere you applied for your Temporary Work Visa. Additionally you mustshow your job offer from your employer along with your passport and traveltickets to the border official. The official is responsible for giving you youractual work permit. The permit will detail who you can work for, in whattype of job and for how long.

You must stick to the terms and conditions of your Temporary Work Permitby leaving Canada when your permit to work ends; failure to do so canresult in you and your dependents being asked to leave Canada early. Youmust obtain a social insurance number (SIN), which you can pick up at theborder of online.

It is possible to extend your work permit after your job finishes, if you havefound another job, if you want to apply for permanent residence or if youwant to leave and then re-enter the country. You can download the forms toextend your stay by clicking this linkhttp://www.cic.gc.ca/english/information/applications/extend-worker.asp

http://www.cic.gc.ca/english/information/applications/extend-worker.asp

THIS FORM HAS BEEN ESTABLISHED BY THE MINISTER OF CITIZENSHIP, IMMIGRATION AND MULTICULTURALISMFORMULAIRE ÉTABLI PAR LE MINISTRE DE LA CITOYENNETÉ, DE L'IMMIGRATION ET DU MULTICULTURALISME

My current mailing address. All correspondence will go to this address unless you indicate your e-mailaddress below, thereby authorizing correspondence, including file and personal information, be provided tothe specified e-mail address. If you wish to authorize the release of information from your case file to arepresentative, indicate their address below and on the form IMM 5476.Mon adresse postale actuelle. Toute la correspondance sera envoyée à cette adresse, sauf si vous fournissezune adresse de courriel, auquel cas la correspondance autorisée, y compris vos renseignements personnels,sera envoyée à cette adresse de courriel. Si vous désirez autoriser la transmission de renseignementsconcernant votre dossier à un représentant, indiquez son adresse ci-dessous et sur le formulaire IMM 5476.

APPLICATION FOR A WORK PERMIT MADE OUTSIDE OF CANADADEMANDE D'UN PERMIS DE TRAVAIL PRÉSENTÉE À L'EXTÉRIEUR DU CANADA

IMM 1295 (12-2009) B

PAGE 1 OF/DE 2Citizenship andImmigration Canada

Citoyenneté etImmigration Canada

2 3

1 Surname (Family name) - Nom de famille First name - Prénom Middle name - Autre(s) prénom(s)

My residential address (if different from your mailing address)Mon adresse personnelle (si elle est différente de votre adresse postale)

PROTECTED WHEN COMPLETEDPROTÉGÉ UNE FOIS REMPLI - B

DO NOT WRITE IN THIS SPACEESPACE RÉSERVÉ

File - Référence

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I want service in:Je veux être servi(e) en :

EnglishAnglais

FrenchFrançais

Officer - Agent

Place of birth - Lieu de naissanceDate of birth-Date de naissanceCity/Town - Ville/Village Prov./State - Prov./État Country - Pays

Citizen of - CitoyennetéD - JMY - A

Present marital status - État civil

WidowedVeuf (Veuve)

DivorcedDivorcé(e)

SeparatedSéparé(e)

Unmarried (never married)Célibataire

MarriedMarié(e)

EngagedFiancé(e)

Sex - Sexe

MaleHomme

FemaleFemme

Common lawConjoint de fait

4 5 6

7 8

Telephone numberNuméro de téléphone

Fax numberNuméro de télécopieur

E-mailCourriel

Personal details of family members (spouse or common-law partner and dependent children)Renseignements sur les membres de ma famille (conjoint(e) ou conjoint(e) de fait et enfants dépendants)

SPOUSE OR COMMON-LAW PARTNER AND CHILDRENÉPOUX OU CONJOINT DE FAIT ET ENFANTS

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APPLICANTREQUÉRANT

SELFLUI-MÊME

Will accompany you to Canada?Vous accompagnera au Canada?

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

Family nameNom de famille

First and second namesPrénom(s)

RelationshipLien de parenté

Date of birthDate de naissance

Place of birthLieu de naissance

Your native languageVotre langue maternelle

CitizenshipCitoyenneté

Passport no.N° de passeport

Passport expiry dateDate d'expiration du passeport

Marital statusÉtat matrimonial

If your native language is not English orFrench, which language do you usemost frequentlty?Si votre langue maternelle est autre quele français ou l'anglais, quelle langueutilisez-vous le plus fréquemment?

EnglishAnglais

NeitherNi l'une ni l'autre

FrenchFrançais

EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais

D - JMY - A D - JMY - A D - JMY - A D - JMY - A


IMM 1295 (12-2009) B

Length of stay - Durée du séjour

a) Within the past two years, have you or a family member had tuberculosis of the lung or been in close contact with a person with tuberculosis of the lung? Au cours des deux dernières années, avez-vous eu, vous ou un des membres de votre famille, la tuberculose pulmonaire ou été en contact avec unepersonne qui a la tuberculose pulmonaire?

b) Do you or an accompanying family member have any physical or mental disorder for which that person will require social and/or health services, otherthan medication, during the stay? Avez-vous, vous ou un des membres de votre famille qui vous accompagne, un trouble physique ou mental qui nécessiterait des services sociaux et/ou des soins de santé autres que des médicaments durant le séjour?

Have you or any member of your family ever:Est-ce que vous-même ou tout membre de votre famille :

c) Committed, been arrested or charged with any criminal offence in any country?Avez-vous commis, ou avez-vous été arrêté pour avoir commis ou accusé d'avoir commis une infraction pénale quelconque dans n'importe quel pays?

d) Been refused admission to, or ordered to leave Canada?Vous a-t-on jamais refusé l'admission au Canada, ou enjoint de quitter le Canada?

e) Applied for any Canadian Immigration visas (e.g. Permanent Resident, Student, Worker, Temporary Resident (visitor), Temporary Resident Permit)?Avez-vous demandé un visa canadien auparavant?(par exemple, un visa de résident permanent, d'étudiant, de travailleur, de résident temporaire [visiteur] ou un permis de séjour temporaire)?

f) Been refused a visa to travel to Canada?Vous a-t-on jamais refusé un visa pour le Canada?

g) In periods of either peace or war, have you ever been involved in the commission of a war crime or crime against humanity, such as: willful killing,torture, attacks upon, enslavement, starvation or other inhumane acts committed against civilians or prisoners of war; or deportation of civilians? En période de paix ou de guerre, avez-vous déjà participé à la commission d'un crime de guerre ou d'un crime contre l'humanité, c'est-à-dire de tout acte inhumain commis contre des populations civiles ou des prisonniers de guerre, par exemple, l'assassinat, la torture, l'agression, la réduction enesclavage ou la privation de nourriture, etc., ou encore participé à la déportation de civils?

If you answer "yes" to any of the questions c) to g) above, you must provide details in the box below marked "Related information". Si vous répondez « oui » à l’une ou plusieurs des questions c) à g) ci-dessus, vous devez fournir des détails dans cette case « Détails ».

The name and address of my employer and the type of business are - Nom et adresse de mon employeur (préciser également le genre d'entreprise)13

My present job is (Give your job title and a brief description of your position)Profession actuelle (Indiquer le titre de votre emploi et une brève description du poste)

I have held mypresent job for

The name and address of my prospective employer in Canada are (Attach original offer of employment)Nom et adresse de mon employeur éventuel au Canada (Joindre l'original de l'offre d'emploi)

If answer to question 20 is "yes" list countries and length of staySi la réponse à la question 20 est affirmative, indiquer le nom de ces pays et la durée du séjour

PAGE 2 OF/DE 2

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14

12

21

From - De To - À

Month(s)Mois

Year(s)An(s)

During the past five years have you or any family member accompanying you lived in any other country than your country of citizenship or permanent residence for more than six months?Au cours des cinq dernières années, avez-vous ou n'importe quel membre de votre famille vous accompagnant a-t-il vécudans un autre pays que votre pays de citoyenneté ou de résidence permanente pendant plus de six mois?

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20

16

17

YesOui

NoNon

J'occupe monemploi actuel depuis

My employment is expected to finish onIl est prévu que mon emploi prendra fin le

I am expected to start my employment onJe suis censé commencer à travailler le

My salary will be - Mon salaire sera de

$ Cdn. $ (Canadiens)

My occupation in Canada will be (Give your job title and a brief description of your position)Ma profession au Canada sera (Indiquer le titre de votre emploi et une brève description du poste)

The information you provide on this form is collected under the authority of theImmigration and Refugee Protection Act to determine if you may be admitted toCanada as a worker. It will be stored in Personal Information Bank CIC PPU 051,Foreign Student Records and Case File. It is protected and accessible under thePrivacy Act and the Access to Information Act.

Les renseignements fournis sur ce formulaire sont recueillis en vertu de la Loi surl'immigration et la protection des réfugiés pour établir si vous êtes admissible auCanada à titre de travailleur. Ils seront versés au fichier de renseignementspersonnels CIC PPU 051, Dossier et fichier des étudiants étrangers. Ils sontprotégés et accessibles en vertu de la Loi sur la protection des renseignementspersonnels et de la Loi sur l'accès à l'information.

"X" THE APPROPRIATE BOXINSCRIRE « X » DANS LA CASE APPROPRIÉE

Related information - Détails

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YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

NameNom

CountryPays

22 I declare that I have answered all required questions in thisapplication fully and truthfullyJe déclare avoir donné des réponses exactes et complètesà toutes les questions de la présente demande Date

D-JMY-A

Signature of applicant - Signature du requérant

18Y - A M D - J Y - A M D - J

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A




IMM 1295 (12-2009) B



2 3





File - Référence

10


EnglishAnglais

FrenchFrançais

Officer - Agent




WidowedVeuf (Veuve)

DivorcedDivorcé(e)



MarriedMarié(e)

EngagedFiancé(e)

Sex - Sexe

MaleHomme

FemaleFemme


4 5 6

7 8



E-mailCourriel



9

APPLICANTREQUÉRANT

SELFLUI-MÊME


YesOui

NoNon

YesOui

NoNon

YesOui

NoNon












EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais



IMM 1295 (12-2009) B
















PAGE 2 OF/DE 2

11

14

12

21

From - De To - À

Month(s)Mois

Year(s)An(s)


15

20

16

17

YesOui

NoNon











19

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

NameNom

CountryPays


D-JMY-A


18Y - A M D - J Y - A M D - J

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A




IMM 1295 (12-2009) B



2 3





File - Référence

10


EnglishAnglais

FrenchFrançais

Officer - Agent




WidowedVeuf (Veuve)

DivorcedDivorcé(e)



MarriedMarié(e)

EngagedFiancé(e)

Sex - Sexe

MaleHomme

FemaleFemme


4 5 6

7 8



E-mailCourriel



9

APPLICANTREQUÉRANT

SELFLUI-MÊME


YesOui

NoNon

YesOui

NoNon

YesOui

NoNon












EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais

EnglishAnglais


FrenchFrançais



IMM 1295 (12-2009) B
















PAGE 2 OF/DE 2

11

14

12

21

From - De To - À

Month(s)Mois

Year(s)An(s)


15

20

16

17

YesOui

NoNon











19

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

YesOui

NoNon

NameNom

CountryPays


D-JMY-A


18Y - A M D - J Y - A M D - J

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

D - JMY - A

DayMonthYear

We, and of

, county of in in the country of

, solemnly declare that we have cohabited in a conjugal relationship for continuous year(s) from

to .DayMonthYear

If none of the above sections applies, what other documentary evidence do you have that would indicate your relationship as common-law partners?

Information to be provided on the Statutory Declaration of Common-law Union is collected under the authority of the Immigration and Refugee Protection Act and is required to determine your eligibility orthat of your partner with respect to an application for sponsorship, an application for permanent residence or an application for temporary residence. It may be used to enforce any provisions of the Act orits regulations and may be provided to provincial authorities pursuant to federal/provincial information exchange agreements. Information you provide on this form will be stored in Personal InformationBanks CIC PPU 013 (Sponsors of immigrants), CIC PPU 015 (Immigration case files), CIC PPU 051 (Foreign students records and case file), CIC PPU 053 (Permanent resident data system), CIC PPU 054(Foreign workers records and case file). It is protected and accessible under the provisions of the Privacy Act and the Access to Information Act. Instructions for obtaining information are provided inInfoSource, a copy of which is located in all Citizenship and Immigration offices.

(DISPONIBLE EN FRANÇAIS - IMM 5409 F)

PROTECTED WHEN COMPLETED - A

STATUTORY DECLARATION OF COMMON-LAW UNION

IMM 5409 (04-2009) E

Citizenship andImmigration Canada


this day of of the year

Signature of Commissioner of Oaths

Name of declarant Signature of declarant

county of

in the province/state/territory of in (country)

SOLEMN DECLARATION

We make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath.

Name of declarant's partner Signature of declarant's partner

5

Declared before me at (City, Town, Village) Commissioner of Oaths (Name)

Country

In the matter of an application made pursuant to the Immigration and Refugee Protection Act and Regulations and in the matter of common-law union,

(IF APPLICABLE)

BEFORE YOU START, READ THE INSTRUCTION GUIDE. TYPE or PRINT in black ink.

PAGE 1 OF 1

My common-law partner and I:

a) Have jointly signed a residential lease, mortgage or purchase agreement relating to a residence in which we both live.

1

b) Jointly own property other than our residence.

c) Have joint bank, trust, credit union or charge card accounts.

I have life insurance on myself which names my common-law partner as beneficiary.

2 My common-law partner has life insurance onhim/herself which names me as beneficiary.

3

4

d) Have declared our common-lawunion under the Canadian Income Tax Act. (T-1 "General - Individual Income Tax Return")

Yes No Yes No

Yes NoYes No Yes No Yes No

Province/State/Territory

(name of declarant) (name of declarant's partner)

(name of city, town, village) (if applicable) (name of province, state, territory)

(name of country)

IMM

(10-2008)E

5476

(DISPONIBLE EN FRANÇAIS - IMM 5476 F)

USE OF A REPRESENTATIVE

Citizenship andImmigration Canada


SECTION A: APPLICANT INFORMATION

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants

PAGE 1 OF 2

IMM 5476 (10-2008) E

PROTECTED WHEN COMPLETED - B

appointing a representative. Complete Sections A, B and D.

cancelling the appointment of a representative. Complete Section A, C and D.I am:

Family name (Surname)

1. Your full name

Given name(s)

2. Your date of birthYearMonthDay

3. If you have already submitted your application:

Name of office where the application was submitted

Location of office

Type of application (permanent residence, extension of study permit, etc.)

4. Your Citizenship and Immigration Canada Identification number (if known)

Client Identification (ID) orUnique Client Identifier (UCI) number

SECTION B: APPOINTMENT OF REPRESENTATIVE


5. Your representative's full name

Given name(s)

I authorize the following individual to serve as my representative and to conduct business on my behalf with Citizenship and Immigration Canada andCanada Border Services Agency. I authorize Citizenship and Immigration Canada and Canada Border Services Agency to release information from my case file and that of my dependentchildren under 18 years of age to my representative. This authorization is in accordance with the Privacy Act. I am aware that any information which would be subject to exemption, if I had the right of access under the Privacy Act or the Access to Information Act,will likely not be released.

•

•

•

6. Your representative: (choose one)

is UNPAID and is a:

family member or friend

member of a non-governmental or religious organization

member of the Canadian Society of Immigration Consultants, a Canadian provincial or territorial law society, or the Chambre des notaires du Québec.

other

is or will be PAID and is a member in good standing of:

the Canadian Society of Immigration Consultants (CSIC)

a Canadian provincial or territorial law society

the Chambre des notaires du Québec

Membership ID number

A representative is someone who has your permission to conduct business on your behalf with Citizenship and Immigration Canada (CIC) andCanada Border Services Agency (CBSA). You may have one representative only. If you appoint an additional representative, the previousrepresentative will no longer be authorized to conduct business on your behalf and receive information on your case file. Your dependent children aged 18 years or older must complete their own copy of this form if they have a representative.

Which province or territory?



IMM 5476 (10-2008) E

7. Your representative's contact information

PAGE 2 OF 2

Name of firm or organization (if applicable)

Mailing address

Postal code/ZIP

Telephone number

Fax number

E-mail address (if applicable)

The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used in assessing yourapplication according to the requirements of the Act. It will be retained in a Personal Information Bank identified in Infosource. It may be shared with otherorganizations in accordance with the consistent use of information under the Privacy Act. Under the Privacy Act and the Access to Information Act individualshave the right to protection of and access to their personal information. Details on these matters are available at infosource.gc.ca and through the Citizenship andImmigration Call Centre. Infosource is also available in Canadian public libraries.

Country code Area code Number

( ) ( )Country code Area code Number

( )

8. Your representative's declaration:

Signature of representative

DateYearMonthDay

SECTION C: CANCEL THE APPOINTMENT OF A REPRESENTATIVE


9. Your representative's full name

Given name(s)

I withdraw my authorization for this person to serve as my representative, to receive information on my case file and to conduct business on my behalf withCitizenship and Immigration Canada and Canada Border Services Agency.

Name of firm or organization(if applicable)

SECTION D: YOUR DECLARATION

10.

Signature of applicant

DateYearMonthDay

I declare that the information I have given is truthful, complete and correct. I understand all the foregoing statements, having asked for and obtained an explanation for every point that was not clear to me.

••

Signature of spouse or common-law partner(if applicable)

DateYearMonthDay

I declare that the information in Section B is truthful, complete and correct. I understand and accept that I am the person appointed by the applicant to conduct business on the applicant or sponsor's behalf with Citizenship andImmigration Canada and Canada Border Services Agency.

••

Warning! It is a serious offence to give false or misleading information on this form.

( )

By indicating your representative's e-mail address, you are hereby authorizing Citizenship and Immigration Canada to transmit your file and personalinformation to this specific e-mail address.

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