Government of Canada
Immigration, Refugees and Citizenship Canada
Step 1 of 5
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1. Personal information
2. Education
3. Experience
4. Dependents
5. Background
Last name
First name
Eye color--- Select ---blueGreenBrownBlackOthers
Size (cm)
Nationality *
Country of residence
Date of birth *
Place of birth *
Native language
Other languages
Statut marital --- Select ---SingleSpouse/eDivorcedWidower/Widom
Wedding date
Name of the spouse/partner
Passport number
Passport expiration date
Phone number *
Email address *
Complete address
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Please provide your educational information from most recent to least recent.
Name of the establishment
City, Province/Region, Country *
Start date *
End date *
Diploma obtained *--- Select ---Primary schoolHigh school diplomaBachelor degreeMaster's degreeDoctorate degreeOthers
Speciality/Major
Diploma equivalency? --- Select ---YesNo
✕ Supprimer ce diplôme
Add a diploma
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Company/Organization Name *
Position held *
Activity / Functions *
End date (blank if in progress) *
Company/Organization Address *
✕ Supprimer cette expérience
Add an experience
SECTION A: SPOUSE OR PARTNER
Surname
Sex--- Select ---MaleFemale
Size
Marital status--- Select ---SingleSpouse/eDivorcedWidower/Widom
Activity performed
Family relationship--- Select ---HusbandMarrySpouseSpouse
Nationality
Date of birth
Place of birth
Language
Education level--- Select ---Primary schoolHigh school diplomaBachelor degreeMaster's degreeDoctorate degreeOthers
SECTION B: DEPENDENT CHILDREN
Accompanying in Canada--- Select ---YesNo
✕ Delete this child
Add a child
SECTION C: PARENTS (Father, mother, stepfather or stepmother)
Family relationship--- Select ---FatherMotherStepfatherStepmother
Vital signs--- Select ---AliveDeceased
✕ Remove this parent
Add a parent
SECTION D: BROTHER, SISTER, HALF-BROTHER, OR HALF-SISTER
Family relationship--- Select ---BrotherSisterStep-brotherStep-sister
✕ Delete
Add a brother/sister
Have you, or if you are the principal applicant, one of your family members listed in your application for permanent residence in Canada, already:
This declaration is mandatory. Any false statement may result in your application being refused.
Question
Réponse
1. Were you convicted of a crime or offence in Canada for which a pardon has not been granted under the Criminal Records Act of Canada?
---YesNo
2. Have you been convicted, or are you currently accused, on trial, or a party to a crime or offence, or subject to criminal proceedings in another country?
3. Déposé une demande précédente de protection des réfugiés au Canada ou dans un bureau de visa canadien à l'étranger, dans un autre pays ou auprès du HCR ?
4. Été refusé le statut de réfugié, un visa d'immigrant ou de résident permanent pour le Canada ou tout autre pays ?
5. Were you refused entry to Canada or any other country, or were you forced to leave these countries?
6. Été impliqué dans un acte de génocide, un crime de guerre ou dans la commission d'un crime contre l'humanité ?
7. Used, planned or advocated for the use of armed struggle or violence to achieve political, religious or social goals?
8. Été associé à un groupe qui a utilisé ou plaide en faveur de la lutte armée ou de la violence pour atteindre des objectifs politiques, religieux ou sociaux ?
9. Été membre d'une organisation engagée dans une activité faisant partie d'un schéma d'activité criminelle ?
10. Were you detained, incarcerated, or imprisoned?
11. Have you had a serious illness or a physical or mental disorder?
Kinship in Canada (if applicable)
Do you (or your spouse) have any close relatives in Canada? --- Select ---YesNo
Family relationship --- Select ---PartnerParentBrotherSisterStep-brotherStep-sister
Province of residence in Canada --- Select ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNouvelle-ÉcosseOntarioPrince Edward IslandQuébecSaskatchewanNorthwest TerritoriesNunavutYukon
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