WORKER INFORMATION SHEET

SECTION 1: Necessary information from the foreign worker

PERSONAL INFORMATION
Name (and first name(s)) complete at birth
** At birth means the name he had at birth, it
depends on the country sometimes people change
it when they get married.
Name (and first name(s)) after marriage
(if applicable)
**If you take the last name of your husband/wife.
Phone number:
Contact information
Email address:
Civic number:
Street:
Apartment:
Current residential address City:
Province/State:
ZIP Code:
Country/Territory:

Citizenship (s)
If more than one citizenship, which one
would you like to apply for?
Are you a permanent resident of the United
Yes ☐ No ☐
States of America? (Green Card)
Yes ☐ No ☐
Do you already hold a permit or visa for Document title:
Canada?
Expiration date:
Do you hold a Quebec Selection
Yes ☐ No ☐
Certificate? (CSQ)
 LANGUAGES
Mother tongue(s)
Spoken language(s)
Can you communicate in French or English
(specify)
In which language are you most
English ☐ French ☐
comfortable communicating?
Have you had your proficiency in French or
English assessed by an approved
assessment body (specify)
STUDIES
Total number of years of study
For each secondary or post-secondary diploma obtained, provide the following information:
School’s name:
City and country of the establishment:
Diploma 1
Title of diploma obtained:
(secondary)
Start and end date of the study period
(Year/Month):
School’s name:
City and country of the establishment:
Diploma 2
Title of diploma obtained:
(post-secondary)
Start and end date of the study period
(Year/Month):
School’s name:
City and country of the establishment:
Diploma 3
Title of diploma obtained:
(post-secondary)
Start and end date of the study period
(Year/Month):
School’s name:
City and country of the establishment:
Diploma 4
Title of diploma obtained:
(post-secondary)
Start and end date of the study period
(Year/Month):

MARITAL STATUS
1. What is your current marital status?
Date of start of marriage/common-law relationship
*Common-law relationship means that you live with
someone for more than a full year or have children
together.
Name(s) and first name(s), as they appear on the
passport, of the current spouse/common-law
partner
Name(s) and first name(s), at birth, of current
spouse/common-law partner
Date of birth of your current spouse/common-law
partner
Is your spouse/common-law partner being a
permanent resident of Canada? Of the United
States?
2. Previous marital status
Have you ever been married or in a common-law
relationship? If yes, answer the following Yes ☐ No ☐
question:
Date of start of marriage/common-law relationship
Marriage/common-law relationship end date
Name(s) and First name(s) of your previous
spouse/common-law partner
Date of birth of your previous spouse/common-
law partner
3. Is your spouse/common-law partner
Yes ☐ No ☐
accompanying you to Canada?
INTERNATIONAL TRAVEL
Date:
Place of arrival
4. First entry into Canada (city/airport):
Reason for the visit:
Date :
5. Last entry into Canada Place of arrival
(if different from first) (city/airport):
Reason for the visit:

6. In the past 5 years, have you lived in Start date of stay (Y/M/D):
a country/territory other than that of End date of stay (Y/M/D):
your citizenship or your current
Country:
residence for more than 6 months? If
yes, for each country: Status in this country:
 BACKGROUND
In the past two years, have you or a member of your family had tuberculosis or been in close
contact with someone who has had tuberculosis?

Yes ☐ No ☐

Details:
Name of the family member and relationship:
Do you have a physical or mental disorder that would require social services and/or health care
other than medication, during your stay in Canada?

Yes ☐ No ☐

Details:

Did you remain in Canada after your status expired, attended school without a study permit in
Canada, worked without a work permit in Canada?

Yes ☐ No ☐

Details:

Have you ever been refused a visa or permit, denied entry or asked to leave Canada or any
other country or territory?

Yes ☐ No ☐

Details:

Have you ever applied to enter or remain in Canada?

Yes ☐ No ☐

Details:

Have you ever committed, been arrested, accused, or convicted of any criminal offense in any
country/territory?

Yes ☐ No ☐

Details:
 BACKGROUND CONTINUED…
Have you been part of an army, militia, civil defense unit, intelligence service or police force
(including non-compulsory national service and reserve units or volunteers)?

Yes ☐ No ☐

Start date of service:

End of service date:

Country:

Are you, or have you ever been, a member or affiliate of a political party or other group or
organization that has used or advocated violence for the purpose of achieving a political or
religious objective, or who have been involved in criminal activity in the past?

Yes ☐ No ☐

Details:

Have you witnessed or participated in the mistreatment of prisoners or civilians or acts looting or
desecration of religious buildings?

Yes ☐ No ☐

Details:
SECTION 2: List of documents to be provided

**Unless otherwise indicated, photocopies are sufficient.

**If the documents are in a language other than French or English, attach, with a copy of the
original document, the original translation carried out by an official translator.

A. Documents required

- Passport
- Up-to-date and complete curriculum vitae (CV):

 Full current contact details

 All occupations for at least the last 10 years:

 Job title
 Name of employer
 City, province/state and country of employment
 Number of hours worked per week
 Start date of employment (Year/Month/Day)
 End date of employment (Year/Month/Day)
 Description of the tasks/functions related to the job

- Work certificate(s), or pay stubs, for each relevant job mentioned in the CV
- Secondary and post-secondary diploma(s)
- Transcript of records related to each diploma

B. If applicable

- Passport of your spouse / common-law partner

- Permanent Resident Card of the United States of America (Green Card), for you and / or
your spouse / common-law partner
- All Quebec Acceptance Certificates (CAQ) obtained
- All work permits and visas obtained for Canada
- Quebec Selection Certificate (CSQ)
- Proof of filing the application for permanent residence in Canada
- National identity document
- Passport size photo
- Results of all tests of an official language in English or French