Work Permit Contact Form

This form is submitted by the:

Employee Employer Both

2) Given Name(s):

3) Gender:

Male Female

5) Date of Birth:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December

5) Email Address:

6) Your citizenship:

7) Current place of residence:

8) Your current status in that location:

Citizen Permanent Resident Being sponsored by family member Work visa holder Student visa holder Visitor visa holder I had legal status but my permit or visa expired I entered without legal status and still have none Recognized refugee or protected person Refugee or asylum claimant I am not sure of my status

9) Provide an honest self-assessment of your ability in each of Canada’s official languages, English and French.

For each heading please choose among the following numbers to describe your abilities:

4 = High;   3 = Moderate;   2 = Basic;   1 = Not at all

English –

Speak: 1 2 3 4   Write:  1 2 3 4   Read: 1 2 3 4   Understand: 1 2 3 4

French –

Speak: 1 2 3 4   Write:  1 2 3 4   Read: 1 2 3 4 Understand: 1 2 3 4

10) What is the highest level of formal studies completed by you?

Post-graduate: doctorate, master’s Professional: lawyer, engineer, medical doctor, etc. University: first-level university degree College: diploma Certificate: specialized studies certificate High School: completed

Please list your degrees / diplomas, name and place of school, year obtained, and specialty (example, business administration) here.

11) Number of years of formal education beginning with grade 1:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

12) Briefly describe the type of employment position you are seeking in Canada.

13) Please describe your work history.  Type or paste your short-form curriculum vitae / résumé here.

14) Are you married or in a common-law relationship?

Yes No

15)Do you have any dependent children?  If yes, how many?

No 1 2 3 4 5 6 7 8 9 10

16) If you have any questions or comments, please type them here.

Now read the Conditions of Use at the end of this form and then click the Submit button, or, if you are submitting this form jointly with the employer, click Submit once the employer answers the questions below.

Questions to be answered by the EMPLOYER:

17) Please provide the full name and location of your business.

18) Please provide the coordinates for the contact person of your business:

19) Describe your business activity to us.  Maximum 50 words please.

20) Is your business Canadian owned, or a subsidiary of a non-Canadian business?

Our business is Canadian owned Our business is foreign owned

21) How many employees work for your business?

22) Please list each position you wish to fill, tell us how many employees you are seeking for each position, and provide a brief job description and the requirements (education, training, experience) for each post.  Maximum 50 words for each position please.

23) Has your business hired foreign workers before?

Yes No

24) If you have any questions or comments, please type them here.

Now read the Conditions of Use below then click the Submit button, or, if you are submitting this form jointly with the employee, click Submit once the employee has answered the questions relevant to him or her.