Representative

LMIA Application Form

(LMIA) Labour Market Impact Assessment
Update version: 11.13.2014

IMPORANT REMINDER: Please note that Global Hire will not be able to send the application with missing information. Employers
are required to give all necessary details, information and documents for the approval of this application. Missing information
may result to delays or refusal of your application. This form is for internal use only.
New Client Existing Client Returning Client Referral

1. PRIMARY CONTACT'S INFORMATION

Company Legal Name Business Operating As (if applicable)

Company G.S.T # Date Of Business Started (mm-dd-yyyy) Employer I.D Number

___ ___ ___ ___ ___ ___ ___ ___ ___ RP 0001

Business Address (Headquarters, Main office address)

Unit/Suite Number Street Name City/Town Province Country Postal Code

Job Location (if different from Business Address)

Unit/Suite Number Street Name City/Town Province Country Postal Code

Mailing Address of the business

Unit/Suite Number Street Name City/Town Province Country Postal Code

Employer's Name Employer's Job Title/Position In The Company

Business Phone Number Primary Contact Number Primary Fax Number

Employer's Email Address Company Website

2. SECONDARY CONTACT'S INFORMATION

Contact Name Job Title/Position In The Company

Contact Number Fax Number

Email Address Other Contact Number

3. BUSINESS INFORMATION

Trucking Hotel & Hospitality Hairs Salon Caregiver

Fast Food Service Welding Machine Operation Day care
Medical Industry Carpentry Material Handling School

Manufacturing Concrete Heavy duty cleaning Government

Light Duty Cleaning Drywall Roofing company Industrial

Oil Field Industry Bakery Warehouse Engineering

Construction Restaurant Painting company Power plant

Landscaping Gas Station Office Service Automotive

Other service/ industry not listed above:
________________________________________________________________________________________________________________

Please check the appropriate type business:

Incorporated / Limited Partnership Sole Proprietor

Other: Specify: __________________________________

Is this a business franchise? Yes No

If yes, provide the name of the corporation:

________________________________________________________________________________

If your business is a franchise, is the corporate head office aware of this application for temporary foreign workers (TFW)?

Yes No Not applicable

If not applicable specify the reason: _________________________________________________

4. COMPANY INFORMATION

Do you have an existing HRSDC Job Bank Account? Yes No Not applicable

If yes; please provide us the following;

Username: Password:

Did you employ a TFW (as the result of receiving a positive LMIA) in the last two years, prior to December 31, 2013?

Yes No

If your answer is YES: did you provide all TFW/s employed by you in the last two years with wages, working conditions and
employment in an occupation that were substanstially the same as those that were described in the offer(s) of employment (and
confirmed in the LMIA letter(s) and annexe(s))? Yes No
Have you applied for and received a positive (approved) LMIA on or before December 31, 2013, and employed a TFW in that
position? Yes No

If your answer is YES: did you provide all TFW/s employed by you, on LMIAs received on or after December 31, 2013, with
employment in the same corporation as described in the offer(s) of employment (and confirmed in the LMIA Letter(s) and
annexe(s)) and with substantially the same wages and working conditions-but not less favorable than- those set out in that
offer(s) or employment (and confirmed in the LMIA letter(s) and annexe(s))? Yes No

Note: Employers should be aware that with recent changes to the Immigration and Refugee Protection Regulations, the look back
period has changed from 2 to 6 years. However, this changes is not retroactive and, therefore will not be fully implemented until
January 2020

Have you had an LMIA revoked within the previous 2 years from the date you submitted this application? Yes No

If your answer is YES: was the LMIA revoked because you had provided false, misleading or inaccurate information in the context
of a request for an opinion? Yes No If your answer is YES; please provide the details of revocation below;

Date (yyyy-mm-dd) ______________________ System File Number __________________________

If the public policy considerations that justified the revocation are no longer relevant, please provide explanation below;

___________________________________________________________________________________________________________

How many employees currently employed nationally under this Canada Revenue Agency Business number (e.g., 5 franchise are
covered by the business number and there are a total of 100 employees):

Total number of employees currently employed at the work location specified on this application: _____________

How many Canadians & Permanent Residents are currently working for your company? _____________

How many total numbers of employees working in this occupation at this work location? _____________

Specify the wage range for these employees:

Low-Wage: $ _______________ /hour High-Wage: $ _______________ /hour

How many (TFW) Temporary Foreign Workers are currently working for your company? __________________

Did your company Lay-Off any workers within the last 12 months? Yes No Not applicable

If yes; please indicate the department and the reason below;

Department: Reason/s:

Does your company offer Employee Benefit Plan? Yes No Not applicable

If your answer is no or not applicable; please indicate the reason below;

Does your business receive support through any Government of Canada program (e.g., Work-Sharing Program)?

Yes No If yes, please name the program/s below:

5. EMPLOYEE BENEFIT INFORMATION

As per collective agreement Bonuses Commission Dental Benefits

Disability Benefits Gratuities Group Insurance Benefits Life Insurance Benefits
Medical Benefits Mileage Paid Pension Plan Benefits Piece Work
RESP Benefits RRSP Benefits Vision Care Other/s

Other benefit/s not listed above:_________________________________________________________________________________

6. EMPLOYMENT STANDARD

Do your company comply with the HRSDC minimum Employment Standards? Yes No Not applicable

For Construction Industry in Alberta and British Columbia

• A) Vacation = 6% Yes No Not applicable

If your answer is no or not applicable, please indicate the reason below;

• B) Statutory Holidays = 3.6% Yes No Not applicable

If your answer is no or not applicable, please indicate the reason below;

For ALL other industries except Construction Service

• C) Vacation = 4% or 10 days paid vacation Yes No Not applicable

If your answer is no or not applicable, please indicate the reason below;

For all industries in the city of Saskatchewan

• D) Vacation = 3 weeks or 15 days paid vacation Yes No Not applicable

If your answer is no or not applicable, please indicate the reason below;

Which of the following documentation/s do you require for this application?

Canadian Driverse License Drug Test Criminal Record Check Own transportation

Other/s: (please indicate other required documentation/s not listed above;

How many working hours per week is required for this application?
30 Hours 35 Hours 37.50 Hours 40 Hours

Other/s: (please indicate number of hour not listed above)

Would you like to utilize our LMIA Ads Maintenance service? Yes No Not applicable

If your answer is no or not applicable, please indicate the reason below;

7. FOREIGN WORKER INFORMATION
Indicate The Type/S Of Job Position You Are Applying For This Application

1) Job Position Number Of Needed Worker/S

2) Job Position Number Of Needed Worker/S

3) Job Position Number Of Needed Worker/S

Please indicate the best way to receive applicants/candidates resumes below;

In Person Via email Via Fax Via mail Via Phone

Please specify email or mailing address if different from the one you have provided on Section 1 of this questionnaire;

Do you have a specific (TFW) Temporary Foreign Worker/ candidate that you would want to hire? Yes No

If your answer is yes; please give us the (TFW) Temporary Foreign Worker's information by filling up the Worker's Information
details below. Otherwise, put N/A. If you need additional sheet please inform our Global Hire representative.

WORKER #1:
Worker's Name (LAST NAME, FIRST NAME) (GENDER)
Male Female
Date of Birth (mm-dd-yyyy) Place of Birth Citizenship

Previous City & Country of Residence Current City and Country of Residence

City: ___________________ Country: __________________ City: ___________________ Country: __________________

What is his/her status in Canada?

Visitor Work Permit Open Permit Student Refugee Under Restoration Lost Status
Other/s: Please indicate status not listed above;

What is the expiration of his/her status in Canada? (mm-dd-yyyy)

WORKER #2:
Worker's Name (LAST NAME, FIRST NAME) (GENDER)
Male Female
Date of Birth (mm-dd-yyyy) Place of Birth Citizenship

Previous City & Country of Residence Current City and Country of Residence

City: ___________________ Country: __________________ City: ___________________ Country: __________________

What is his/her status in Canada?

Visitor Work Permit Open Permit Student Refugee Under Restoration Lost Status
Other/s: Please indicate status not listed above;
What is the expiration of his/her status in Canada? (mm-dd-yyyy)
WORKER #3:

Worker's Name (LAST NAME, FIRST NAME) (GENDER)

Male Female
Date of Birth (mm-dd-yyyy) Place of Birth Citizenship

Previous City & Country of Residence Current City and Country of Residence

City: ___________________ Country: __________________ City: ___________________ Country: __________________

What is his/her status in Canada?

Visitor Work Permit Open Permit Student Refugee Under Restoration Lost Status
Other/s: Please indicate status not listed above;

What is the expiration of his/her status in Canada? (mm-dd-yyyy)

8. SKILL REQUIREMENT
Do you require education for this application? Yes No Not Applicable
If YES, please indicate below the specific educational attainment that you require; (e.g., High School Graduate, College Graduate, etc.)

If no or not applicable, please indicate the reason bealow;

Do you require specific work experience for the application? Yes No Not applicable

If YES, please indicate below the specific work experience that you require; (e.g., Material Handling, Warehouse, Food Serivce, etc.)

If no or not applicable, please indicate the reason below;

9. ADDITIONAL INFORMATION
In the box below, please indicate any additional information and details you would want us to know and or want to be associated
in this Labour Market Impact Assessment Application process. Otherwise, please put N/A;

10. IMPORTANT REMINDER

• To avoid delays of process please make sure to provide all necessary information required in this application

• If the employer is found to be non-compliant, HRSDC may issue a negative LMIA or refusal and may revoke all positions
on confirmed LMIAs for which work permits have not been issued yet by the CIC Process Centre. They may deem the
employer ineligible to hire TFW for 2 years. The employer's names, address and period of ineligibility may also be
published on the list of ineligible employers posted on the Canadian Immigration & Citizenship website.

• If you have posted ads for this position please include a copy of all advertisements along with this application. We need
to make sure that the information posted in the advertisement is correct based on the HRSDC qualifications and
standards.

• Once the LMIA application is submitted, Global Hire will send you LMIA Information Summary Sheet that will help you
provide in the summary to avoid miscommunications and delays. If you did not receive the LMIA summary within 5-7
days after submission please call your Global Hire representative.
11. APPLICATION CHECKLIST

Completed Global Hire LMIA Questionnaire PD7A Form

Business License Copy (if applicable) Proof of Corporation Document (if applicable)
(Form EMP 5575) Use of Representative (Form EMP 5517) Declaration of Employer
(Form EMP 5512) Declaration of Employer Signed Employment Contract
(Form EMP 5576) Government Fee Payment Employer's Business Card
Form

In this box, please indicate any other information or comments that you would like our Global Hire representative to know in
connection with this application:
RETAINER AGREEMENT
File Number: __________

THIS AGREEMENT made this ___________day of _____________, 2014

BETWEEN:
____________________________________________________________
Global Hire Placement Services Inc.
Unit 210-211, 4935-55 Avenue NW Edmonton, Alberta T6B 3S3
Telephone number: 780 439 3651. Fax number: 780 439 3686
(hereinafter referred to as “RCIC”)
OF THE FIRST PART
- and –
Mr./Ms.__________________________________________________________________________________
Company Name ___________________________________________________________________________
Located at _______________________________________________________________________________
Phone _________________________________ Fax _____________________________________________
(hereinafter referred to collectively as “the Client(s)”)

OF THE SECOND PART

• WHEREAS the RCIC and the Client wish to enter into a written agreement which contains the agreed upon terms and conditions upon which the RCIC will
provide his/her services to the Client.
• AND WHEREAS the RCIC is a member of Immigration Consultants of Canada Regulatory Council (the “Council”), the regulator in Canada for immigration
consultants;
IN CONSIDERATION of the mutual covenants contained in this Agreement, the parties agree as follows;
1. Definitions
The terms “Client”, “Council”, “Disbursement” and “RCIC” shall have the meaning given to such terms in the Retainer Agreement Regulation of the Council.
2. RCIC Responsibilities and Commitment
The Client asked the RCIC, and the RCIC has agreed, to act for the Client in the matter of ______________________________________________________________.
In consideration of the fees paid and the matter stated above, the RCIC agrees to do the following:
a) _______________________________________________________________________________________________________________________________
b) _______________________________________________________________________________________________________________________________
c) _______________________________________________________________________________________________________________________________
Additional pages attached, if necessary.
3. Client Responsibilities and Commitment
3.1 The Client must provide, upon request from the RCIC:
• All necessary documentation
• All documentation in English or French, or with an English or French translation
3.2 The Client understands that he/she must be accurate and honest in the information he/she provides and that any inaccuracies may void this Agreement, or
seriously affect the outcome of the application or the retention of any status he/she may obtain. The RCIC’s obligations under the Retainer Agreement are null and
void if the Client knowingly provides any inaccurate, misleading or false material information. The Client’s financial obligations remain.
3.3 In the event Citizenship and Immigration Canada (CIC) or Human Resources and Skills Development Canada (HRSDC) should contact the Client directly, the Client is
instructed to notify the RCIC immediately.
3.4 The Client is to immediately advise the RCIC of any change in the marital, family, or civil status or change of physical address or contact information for any
person included in the application.
3.5 In the event of a Joint Retainer Agreement, pursuant to Article 13 of the Code of Professional Ethics, the Clients understand that no information received in

Client's Initials: _____________

connection with the matter from one Client can be treated as confidential so far as any of the other Clients are concerned (Article 13.1.1) and that if a conflict develops
that cannot be resolved, the RCIC cannot continue to act for both or all of the Clients and may have to withdraw completely (Article 13.1.2).
4. Billing method
The Client will be billed by (by the hour or flat fee with payment by milestones or predetermined date);
_______________________________________________________________________________________________________________________________________
The details of this billing method are as follows; (hourly rate charged or the pertinent milestones or predetermined dates and amounts owing)
_______________________________________________________________________________________________________________________________________
5. Payment terms and conditions

Professional Fees $
RCIC's Initials: __________

Other Fees (e.g., Disbursement, Courier Fees, Incorporation Fees, etc.) $

Applicable Taxes (include registered tax numbers) $
Government Fees $
Total Cost/ Charges $

The above amount is to be paid by the client and is subject to change upon mutual agreement of both parties.
 6. Payment Schedule

Deposit $
Balance $

• Deposit must be paid upon signing of this agreement

• Remaining balance must be paid at the time of filing or process

Special arrangements of payment must be mutually agreed by the Client and the RCIC (e.g., payment by post-dated cheques, different currency, etc.) Indicate details of
payment arrangement below; (if applicable)

7. Refund Policy

The Client acknowledges that the granting of a Canadian visa, permits or all other Canadian status and the time required for processing this application is at the sole
discretion of the government and not the RCIC. The Client agrees that the fees paid are for services indicated above, and any refund is strictly limited to the amount
of fees paid. Unused fees will be refunded at the amount of 50% of fees to be paid within 30 days.

8. Dispute resolution related to the code of professional ethics

In the event of a dispute related to the Code of Professional Ethics, the Client and RCIC are to make every effort to resolve the matter between the two parties.
In the event a resolution cannot be reached, the Client is to present the complaint in writing to the RCIC and allow the RCIC 30 days to respond to the Client.
In the event the dispute is still unresolved, the Client may follow the complaint and discipline procedure outlined by the Council on their website:
http://www.iccrc-crcic.ca/public/complaintsDiscipline.cfm
ICCRC Contact Information:
Immigration Consultants of Canada Regulatory Council (ICCRC)
5500 North Service Rd., Suite 1002
Burlington, ON, L7L 6W6
Toll free: 1-877-836-7543
NOTE: All complaint forms must be signed
9. Confidentiality
All information and documentation reviewed by the RCIC, required by CIC and all other governing bodies, and used for the preparation of the application will not be
divulged to any third party, other than agents and employees, without prior consent, except as demanded by law. The RCIC, and all agents and employees of the
RCIC, are also bound by the confidentiality requirements of Article 8.1 and 8.5 of the Code of Professional Ethics.
The Client agrees to the use of electronic communication and storage of confidential information. The RCIC will use his/her best efforts to maintain a high degree of
security for electronic communication and information storage.
10. Force Majeure
The RCIC’s failure to perform any term of this Retainer Agreement, as a result of conditions beyond his/her control such as, but not limited to, governmental
restrictions or subsequent legislation, war, strikes, or acts of God, shall not be deemed a breach of this Agreement.
11. Change Policy
The Client acknowledges that if the RCIC is asked to act on the Client’s behalf on matters other than those outlined above in this Agreement, or because of a material
change in the Client’s circumstances, or because of material facts not disclosed at the outset of the application, or because of a change in government legislation
regarding the processing of immigration-related applications, the Agreement can be modified accordingly.
12. Termination
12.1 This Agreement is considered terminated upon completion of tasks identified under section 2 of this agreement.
12.2 This Agreement is considered terminated if material changes occur to the Client’s application or eligibility, which make it impossible to proceed with services
detailed in section 2 of this Agreement.
12.3 This Agreement may be terminated, upon writing, by the Client, at which time any outstanding fees or Disbursements will be refunded by the RCIC to the
Client/any outstanding fees or Disbursements will be remitted by the Client to the RCIC.
12.4 Pursuant to Article 14 of the Code of Professional Ethics, this Agreement may be terminated, upon writing, by the RCIC, provided withdrawal does not cause
prejudice to the Client.
13. Governing Law
This Agreement shall be governed by the laws in effect in the Province/Territory of Alberta, and the federal laws of Canada applicable therein and except for disputes
pursuant to Section 8 hereof, any dispute with respect to the terms of this Agreement shall be decided by a court of competent jurisdiction within the
Province/Territory of Alberta, Canada.
14. Miscellaneous
14.1 This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements,
understandings, warranties, representations, negotiations and discussions, whether oral or written, of the parties except as specifically set forth herein.
14.2 This Agreement shall be binding upon the parties hereto and their respective heirs, administrators, successors and permitted assigns.
14.3 This Agreement may only be altered or amended when such changes are made in writing and executed by the parties hereto.
14.4 The provisions of this Agreement shall be deemed severable. If any provision of this Agreement shall be held unenforceable by any court of competent
jurisdiction, such provision shall be severed from this Agreement, and the remaining provisions shall remain in full force and effect.
14.5 The headings utilized in this Agreement are for convenience only and are not to be construed in any way as additions to or limitations of the covenants and
agreements contained in this Agreement.
14.6 Each of the parties hereto shall do and execute or cause to be done or executed all such further and other things, acts, deeds, documents and assurances as
may be necessary or reasonably required to carry out the intent and purpose of this Agreement fully and effectively.
14.7 The Client acknowledges that he/she has had sufficient time to review this Agreement and has been given an opportunity to obtain independent legal
advice and translation prior to the execution and delivery of this Agreement. In the event the Client did not seek independent legal advice prior to signing this
Agreement, he/she did so voluntarily without any undue pressure and agrees that the failure to obtain independent legal advice shall not be used as a defense to the
enforcement of obligations created by this Agreement. Furthermore, the Client acknowledges that he/she has received a copy of this Agreement and agrees to be
bound by its terms.
14.8 The Client acknowledges that he/she has requested that the Agreement be written in the English language.
15. Contact Information
Client / Designate Name Information

Give Name Middle Name Last Name

Client's Initials: _____________

Contact Number Fax Number Email Address

RCIC Information
Give Name Middle Name Last Name
Contact Number Fax Number Email Address

IN WITNESS THEREOF this Agreement has been duly executed by the parties hereto on the date first above written. The Client acknowledges that he/she (they)
has read this Agreement, understands it, has obtained such independent legal advice as he or she deems it appropriate, have sought translation and agree to be
bound by its terms.

Signature of Client Signed date

RCIC's Initials: __________

Signature of RCIC Signed Date

16. Attachments (as required)

Initial Consultation Agreement Agent Agreement
Designate Authorization Copy of Invoice
Application Form Copy of Government Fee
 PRE
ASSESSMENT
SHEET
 FEE
PAYMENT
FORM
LOW SKILL
FORM
HIGH SKILL
FORM
REP FORM
SCHEDULE
E
FORM
SCHEDULE
C
FORM