BACKGROUND INFORMATION

    Have you applied for CIC for any immigration matter before?

    If yes, select any of the categories below:

    UCI No. (if known):

    Have you received a Provincial Nomination?

    If yes, what Province and when?

    Age of Children (if any):

    Have you, your spouse, or your child ever had any medical problems?

    Have you, your spouse, your child ever been arrested or charged for an offence of any kind, anywhere in the world?

    If yes, please describe how the criminal matter was resolved:

    Do you have any relatives in Canada? If yes, indicate relationship, status,and location of relative in Canada:

    SECONDARY EDUCATION

    How many years of elementary and secondary education did you complete?

    Did you obtain a trade certificate? If yes, what type and which school:

    What year did you graduate?

    POST SECONDARY EDUCATION (BACHELOR’S, MASTERS, or Ph.D):

    Provide the following information for each degree obtained:
    Name of University:
    Number of Years of Study:
    City/Country:
    Study Period: from (mm/yyyy) to (mm/yyyy):
    Did you graduate? IF YES, WHAT YEAR DID YOU GRADUATE?:
    Type of diploma or degree:
    Name of program:
    Full-time or part time studies:

    WORK EXPERIENCE

    Work experience over the last 10 years (paid employment only)
    Provide the following information for your previous work experience:
    Name of Employer:
    From (mm/yyyy) to (mm/yyyy):
    City/Country:
    Hours per week:
    Job Title:
    If a Canadian employer, please provide full address:
    Main duties(describe the daily tasks that you regularly performed):

    In the last 5 years, do you have at least two years of experience in one of these types of jobs (skilled trades)
    Industrial, electrical and construction trades.
    Maintainable and equipment operation trades.
    Supervisors and technical jobs in natural resources, agriculture and related production.
    Processing, manufacturing and utilities supervisors and central control operators.
    Chefs and cooks.
    Butchers and bakers.

    LANGUAGE (ENGLISH)

    Speaking

    Understanding:

    Reading:

    Writing:

    If you have taken an English exam, please fill in the following information:
    Type of Test (IELTS/CELPIP):
    Reference No.:

    Scores per ability
    Speaking:
    Listening:
    Reading:
    Writing:

    LANGUAGE (FRENCH)

    Speaking:

    Understanding:

    Reading:

    Writing:

    If you have taken the TEF, please fill in the information requested below:
    Date Taken:
    Type of Test (IELTS/CELPIP):
    Reference No.:

    Scores per ability
    Speaking:
    Listening:
    Reading:
    Writing:

    Spouse’s Name:
    (FIRST AND LAST NAME)

    Spouse’s Date of Birth:
    (MM/DD/YYYY)

    Spouse’s Telephone:
    Include country code

    Spouse’s Email Address:

    Spouse’s Passport & National ID (if applicable):
    Type of Identification:
    Number:
    Date of Issue(DD/MM/YYYY)
    Expiry Date (DD/MM/YYYY)

    Has your spouse ever applied to CIC for any immigration matter before?

    If yes, select any of the categories below:

    UCI No. (if known):

    Has you spouse received a Provincial Nomination?

    If yes, please answer the following:
    Province:
    Nomination date:

    Does your spouse have relatives in Canada? If yes, indicate relationship, status, and location of relative:

    Spouse’s Secondary Education
    How many years of elementary and secondary education did your spouse complete?
    Elementary:
    Secondary:

    Trade Certificate
    Type of certificate:
    School name:

    Post-Secondary Education
    Name of College or University:
    Number of years of study:
    City/Country:
    Study Period: from (MM/YYYY) to (MM/YYYY)
    Did you graduate? If yes, what year did you graduate?
    Type of Diploma or degree:
    Name of Program:
    Full-time or part time studies:

    SPOUSE’S WORK EXPERIENCE:

    Provide the following information for your previous work experience:
    Name of Employer:
    From (mm/yyyy) to (mm/yyyy):
    City/Country:
    Hours per week:
    Job Title:
    If a Canadian employer, please provide full address:
    Main duties(describe the daily tasks that you regularly performed):

    SPOUSE’S LANGUAGE ABILITY (ENGLISH)

    Speaking

    Understanding:

    Reading:

    Writing:

    If your spouse has taken an English exam, please fill in the following information:
    Type of Test (IELTS/CELPIP):
    Reference No.:

    Scores per ability
    Speaking:
    Listening:
    Reading:
    Writing:

    SPOUSE’S LANGUAGE ABILITY (FRENCH):

    Speaking:

    Understanding:

    Reading:

    Writing:

    If you have taken the TEF, please fill in the information requested below:
    Date Taken:
    Type of Test (IELTS/CELPIP):
    Reference No.:

    Scores per ability
    Speaking:
    Listening:
    Reading:
    Writing:

    If your spouse has taken a French exam, please fill in the information requested below:
    Date Taken:
    Type of Test (IELTS/CELPIP):
    Reference No.:

    Scores per ability
    Speaking:
    Listening:
    Reading:
    Writing:

    PROOF OF FUNDS:

    What is the total dollar value (in Canadian Dollars) of all of you and your spouse’s available money to get established in Canada?

    LOCATION:

    In which of the following provinces and territories would you be prepared to live?
    Check all that apply

    INFORMATION ABOUT YOUR CHILDREN

    Do you or your spouse have children?

    Please provide the following information about your children:
    Name:
    Gender:
    Date of Birth:
    ID NUMBER include and National ID (if applicable):
    Date of Issue (DD/MM/YYYY):
    Expiry Date (DD/MM/YYYY):
    Marital status:
    Coming to Canada with you? (Y/N)

    DECLARATION

    Do you confirm that the information provided above is true?

    Signature:
    (First Name and Last Name)

    Date:
    (MM/DD/YYYY)