foreignapplicationform

1. Last Name: First Name:

2. Mailing Address:

3. Residential Address (if different from mailing):

4. Telephone Number: Fax Number:

5. Birth Date [DD-MM-YYYY]: Gender:

6. Place of birth:

CITY: PROV/STATE: COUNTRY:

CITIZENSHIP:

7. Present Marital Status:

8. Spouse or Common-Law Partner Information:

Last Name: First Name:

Relationship to Applicant: Birth Date [DD-MM-YYYY]:

Place of birth:

CITY: PROV/STATE: COUNTRY:

CITIZENSHIP:

Passport No: Passport Expiry Date [DD-MM-YYYY]:

Marital Status: Will accompany you to Canada?

9. Children or Dependant Information:

Last Name: First Name:

Relationship to Applicant: Birth Date [DD-MM-YYYY]:

Place of birth:

CITY: PROV/STATE: COUNTRY:

CITIZENSHIP:

Passport No: Passport Expiry Date [DD-MM-YYYY]:

Marital Status: Will accompany you to Canada?

Last Name: First Name:

Relationship to Applicant: Birth Date [DD-MM-YYYY]:

Place of birth:

CITY: PROV/STATE: COUNTRY:

CITIZENSHIP:

Passport No: Passport Expiry Date [DD-MM-YYYY]:

Marital Status: Will accompany you to Canada?

Last Name: First Name:

Relationship to Applicant: Birth Date [DD-MM-YYYY]:

Place of birth:

CITY: PROV/STATE: COUNTRY:

CITIZENSHIP:

Passport No: Passport Expiry Date [DD-MM-YYYY]:

Marital Status: Will accompany you to Canada?

Last Name: First Name:

Relationship to Applicant: Birth Date [DD-MM-YYYY]:

Place of birth:

CITY: PROV/STATE: COUNTRY:

CITIZENSHIP:

Passport No: Passport Expiry Date [DD-MM-YYYY]:

Marital Status: Will accompany you to Canada?

Current Job Information:

10. Job Title:

Job Description:

11. I have held my present job and position for: Months:

12. Name and Address and Type of Employer:

Name:

Address:

Type of Employer:

Prospective Job Information:

13. Name and Address of Employer in Canada:

Name:

Address:

14. Job Title:

Job Description:

15. My salary will be:

16. I am expected to START my employment [DD-MM-YYYY]:

17. I am expected to FINISH my employment [DD-MM-YYYY]:

Health Information:

18. 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?

19. Do you or an accompanying family member have any physical or mental disorder for which that person will require

social and/or health services, other than medication during the stay?

Have you or any member of your family ever:

20. Committed, been arrested or charged with any criminal offence in any country?

21. Been refused admission to, or ordered to leave Canada?

22. Applied for any Canadian Immigration visas?

23. Been refused a visa to travel to Canada?

24. 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?

If you answer “yes” to any of questions 20 to 24, please provide details:

25. 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?

If answer to question 25 is “yes”, please list countries and length of stay:

Length of Stay

Name of Individual Country From (DD-MM-YYYY) To (DD-MM-YYYY)