Edu care Canada IMMIGRATION

Applicant Information
A. Personal Information

Last Name (As in passport)

First Name (As in passport)
Any other name previously used?
Present Address
Email address
Phone (with country code) Fax
Height (Inches)
Eye Color
City, Country of Birth
Date of Birth (MM-DD-YYYY)
Native Language (Mother Tongue)
Settlement funds available in CAD $
What city, province do you intend to reside?
Existing PNP application or nomination from any Province (Y/N)
If Yes, please provide expiry date and Name of Province
Passport details

Passport No.
Date of Issue
Date of Expiry
Country/Place of Issue
B. Education Information: Provide dates and location of all educational programs completed (senior secondary
and onwards)
From Date To Date City, Type of Field of
Name of Institution
MM-YYYY MM-YYYY Country Certificate/degree Study

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 Education Credential Assessment Report Details

Name of Agency

Date of Assessment
(MM-DD-YYYY)
Program Assessed

Result of Assessment

IELTS GENERAL CELPIP GENERAL TEF

Language Test Exam Appeared in

Test Report Form No. ☐ ☐ ☐

Test Date (MM-DD-YYYY) Result Date (MM-DD-YYYY)

Listening Reading Writing Speaking

Any Certificate of Qualification (Trade Certificate) from a Canadian province or territory (Y/N) Y
C. Employment Information

Name of Employer
Job Title

Current Job Start Date (MM-DD-YYYY)

Employer Contact Address
Location Address
Have any full time 1 year Job Offer in Canada? (Y/N)

If yes, please provide LMIA copy / LMIA exempt work permit under international, provincial agreement

Work History: Provide a list of all jobs undertaken since the age of 18 or last 10 years (whichever is less)
From Date To Date Hours
Job Title City and Country Name of Employer
MM-YYYY MM-YYYY /Week

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 D. Personal History: Please provide a list of all activities undertaken since the age of 18 or last 10 years
(whichever is less). Examples of activities are Working, Studying, Travelling, Unemployed, In Detention, and
Military etc.) NOTE: Please do not leave any gaps in the personal history
From Date To Date Activity, Status in Name of Company/
City, Country
MM-YYYY MM-YYYY Job Title Country Employer/School

E. Addresses: Please provide a list of all addresses where you have lived since the age of 18 or last 10 years
(whichever is less) NOTE: Please do not leave any gaps in the address history
From Date To Date Apt
DD-MM- DD-MM- Number (if Street Name City/Town Postal Country
YYYY YYYY applicable) Province Code
and
Street
Number

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 F. Travel History: List all dates of travel made outside country of origin and current residence in the last 10 years
or since 18 years of age, whichever is most recent. For additional space, please use the Additional
Comments Section
From Date To Date
City of Travel Country of Travel Purpose of Travel
DD-MM-YYYY DD-MM-YYYY

G. Background Information: Please answer the questions with Yes or No if you or any family member have
1. Been convicted of a crime or offence in Canada for which a pardon has not been granted
under the Criminal Records Act of Canada?
2. Ever committed, been arrested for, been charged with or convicted of any criminal offence in any
country?
3. Made previous claims for refugee protection in Canada or at a Canadian visa office abroad, in any
other country or countries, or with the United Nations High Commissioner for Refugees?
4. Been refused refugee status, or an immigrant or permanent resident visa (including a Certificat
de sélection du Québec (CSQ) or application to the Provincial Nominee Program) or visitor or
temporary resident visa, permit, denied entry or ordered to Canada or any other country?

5. Been involved in an act of genocide, a war crime or in the commission of a crime against humanity?

6. Used, planned or advocated the use of armed struggle or violence to reach political, religious or
social objectives?
7. Been associated with a group that used, uses, advocated or advocates the use of armed struggle or
violence to reach political, religious or social objectives?
9. Been a member of an organization that is or was engaged in an activity that is part of a pattern of
criminal activity?
10. Been detained, incarcerated, or put in jail?

11. Had any serious disease (like tuberculosis, renal failure) or any physical or mental disorder?

12. Have served in any country’s armed forces and performed any military/paramilitary service?

13. Have held any government positions (civil servant, judge, police officer etc.) in any country?

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 If responded Yes to any of the above questions, please provide details in the space below.

H. Family Information

Current Marital Status

SINGLE MARRIED WIDOW COMMON LAW

If MARRIED / COMMON LAW, please provide detail below:

Date of Marriage (MM-DD-YYYY)
Full Name of Partner (First Name, Last Name)
Date of Birth (MM-DD-YYYY)
City, Country of Birth
Height (Inches)
Eye Color
Email address
Highest Level of Education
Present Address of Partner
Present Occupation of Partner
Intended Occupation of Partner
If Widow, please provide detail below:
Date of Death (MM-DD-YYYY)
City of Deceased
Passport details of partner
Passport No.
Date of Issue
Date of Expiry
Country/Place of Issue
Previous Marriage (if applicable)
Were you previously MARRIED or in a COMMON-LAW relationship?
YES NO
If YES, please provide detail about your previous spouse or partner below:
Full Name of Partner (First Name, Last Name)
Type of relationship MARRIED COMMON LAW

From (MM-DD-YYYY)
To (MM-DD-YYYY)
Date of Birth (MM-DD-YYYY)

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 Parents Information: Provide information about your father and mother

Full Name

Date of birth (MM-DD-YYYY)

City, Country of Birth

Father Marital Status

Present Address

Email address

Present Occupation
If deceased, Date and City of
Death (MM-DD-YYYY)
Full Name

Date of birth (MM-DD-YYYY)

City, Country of Birth

Mother
Marital Status

Present Address

Email address

Present Occupation
If deceased, Date and City of
Death (MM-DD-YYYY)
Sibling Information: List your brothers/sisters/half-brothers/half-sisters/step-brothers/step-sisters
City, Country of
Date of birth Marital
Name Relationship Place of birth Residence/If deceased,
Status
(MM-DD-YYYY) Date and City of
Deceased

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 Children Information: List your son/daughter/step-son/step-daughter
Eye Marital City, Country City, Country of
Name Relationship Height
Color Status of Birth Residence

Family Members in Canada: List all relatives of you or your spouse living in Canada
Status in
Name Relationship Present Address
Canada

Additional Comments: Provide any other information relevant to your application

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