Personal Information Form
Please fill in the blank spaces as accurately as possible. If it does not apply put N/A. If you have more information then the spaces provided, add your information on a separate sheet and attach it to this form.
Section 1: Personal Information
Name:
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
Country of Birth
*
City of Birth
*
Citizenship
*
Have You Ever Used Any Other Name (IE. Nickname, Maiden Name, Alias, ETC.)?:
*
No
If Yes, Please Indicate Below
Other Name:
Gender:
*
Please Select
Male
Female
Other
Eye Colour:
*
Please Select
Black
Brown
Blue
Green
Sea Green
Hazel
Grey
Other
Height:
*
Native Language:
*
Do You Speak English And/Or French?
*
Please Select
English
French
Both
Neither
Current Residential Address:
*
Contact Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Telephone Type:
*
Please Select
Residence
Business
Cellular
Email:
*
example@example.com
Passport #:
*
Country of Issue:
*
Date of Issue:
*
-
Month
-
Day
Year
(MM/DD/YYYY)
Expires On:
*
-
Month
-
Day
Year
(MM/DD/YYYY)
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Section 2: Marital Information
Marital Status:
*
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Date of Marriage Or Entered Into Common Law:
-
Month
-
Day
Year
(MM/DD/YYYY)
Previously married or/and been in common-law relationships?:
Yes
No
If yes, provide the full name, date of birth, start and end date of marriage and type of relationship (common-law or married) with your previous spouse(s).
Spousal Information
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Gender:
Please Select
Male
Female
Other
Eye Colour:
Please Select
Black
Brown
Blue
Green
Sea Green
Hazel
Grey
Other
Height:
Native Language:
Do You Speak English And/Or French?
Please Select
English
French
Both
Neither
Occupation:
Current Residential Address:
Contact Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Telephone Type:
Please Select
Residence
Business
Cellular
Email:
example@example.com
Previously married or/and been in common-law relationships?:
Yes
No
If yes, provide the full name, date of birth, start and end date of marriage and type of relationship (common-law or married) with your previous spouse(s).
Passport #:
Country of Issue:
Date of Issue:
-
Month
-
Day
Year
(MM/DD/YYYY)
Expires On:
-
Month
-
Day
Year
(MM/DD/YYYY)
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Section 3: Children Information
Child 1
Name:
First Name
Last Name
Relationship To Child:
(BIOLOGICAL, STEP-CHILD, ETC.)
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Gender:
Please Select
Male
Female
Other
Eye Colour:
Please Select
Black
Brown
Blue
Green
Sea Green
Hazel
Grey
Other
Height:
Native Language:
Do You Speak English And/Or French?
Please Select
English
French
Both
Neither
Marital Status:
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Passport #:
Country of Issue:
Date of Issue:
-
Month
-
Day
Year
(MM/DD/YYYY)
Expires On:
-
Month
-
Day
Year
(MM/DD/YYYY)
Address
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence
Country of Residence
Child 2
Name:
First Name
Last Name
Relationship To Child:
(BIOLOGICAL, STEP-CHILD, ETC.)
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Gender:
Please Select
Male
Female
Other
Eye Colour:
Please Select
Black
Brown
Blue
Green
Sea Green
Hazel
Grey
Other
Height:
Native Language:
Do You Speak English And/Or French?
Please Select
English
French
Both
Neither
Marital Status:
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Passport #:
Country of Issue:
Date of Issue:
-
Month
-
Day
Year
(MM/DD/YYYY)
Expires On:
-
Month
-
Day
Year
(MM/DD/YYYY)
Address
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence
Country of Residence
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Section 4: Additional Family Information
(INCLUDE PARENTS, BROTHERS, SISTERS, HALF-SIBLINGS AND STEP SIBLINGS)
Relationship: Father
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Marital Status:
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Occupation:
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Date of Death (If Applicable):
-
Month
-
Day
Year
Date
City of Death:
Relationship: Mother
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Marital Status:
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Occupation:
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Date of Death (If Applicable):
-
Month
-
Day
Year
Date
City of Death:
Relationship: Other
Other Relationship (1):
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Marital Status:
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Occupation:
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Date of Death (If Applicable):
-
Month
-
Day
Year
Date
City of Death:
Relationship: Other
Other Relationship (2):
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
(MM/DD/YYYY)
City of Birth:
Citizenship:
Country of Birth:
Marital Status:
Please Select
Single
Common-Law
Married
Annulled Marriage
Legally Separated
Divorced
Widowed
Occupation:
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Date of Death (If Applicable):
-
Month
-
Day
Year
Date
City of Death:
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Section 5: Official Language Test Results
Type of Language Test Taken:
*
Please Select
CELPIP
IELTS
Date Language Test Taken:
*
-
Month
-
Day
Year
Date
Date of Test Result:
*
-
Month
-
Day
Year
Date
Language Test Result From Certificate Number
*
Test Scores:
1. Speaking:
*
2. Reading:
*
3. Listening:
*
4. Writing:
*
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Section 6: Education
Numbers of Years Successfully Completed:
*
A) Elementary/Primary School:
Secondary/ High School:
University/College:
Trades/Other Post Secondary School:
(1)
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Full-Time or Part-Time?:
Please Select
Full-Time
Part-Time
Name of School:
City and Country of Study:
Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
Course/Program Study:
Certified/ Degree Obtained:
Please Select
Secondary or Less
Non-University Certificate/Diploma
Post Secondary - No Degree
Post Graduate - No Degree
Bachelor's Degree
Master's Degree
Trade/Apprenticeship Certificate/Diploma
Number of Academic Years:
Did You Complete The Program?:
Please Select
Yes
No
Did You Receive an ECA ffor This Study? (If Yes, Please Attach the ECA):
Yes
No
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If your education was completed in Canada:
Did you complete at least 50% of the study or training program's courses through in-person learning?:
Yes
No
Did you study in Canada for at least 8 months in order to earn this degree, diploma or certificate?:
Yes
No
Did you study full-time for at least 8 months to earn this degree, diploma or certificate?:
Yes
No
(2)
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Full-Time or Part-Time?:
Please Select
Full-Time
Part-Time
Name of School:
City and Country of Study:
Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
Course/Program Study:
Certified/ Degree Obtained:
Please Select
Secondary or Less
Non-University Certificate/Diploma
Post Secondary - No Degree
Post Graduate - No Degree
Bachelor's Degree
Master's Degree
Trade/Apprenticeship Certificate/Diploma
Number of Academic Years:
Did You Complete The Program?:
Please Select
Yes
No
Did You Receive an ECA ffor This Study? (If Yes, Please Attach the ECA):
Yes
No
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If your education was completed in Canada:
Did you complete at least 50% of the study or training program's courses through in-person learning?:
Yes
No
Did you study in Canada for at least 8 months in order to earn this degree, diploma or certificate?:
Yes
No
Did you study full-time for at least 8 months to earn this degree, diploma or certificate?:
Yes
No
(3)
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Full-Time or Part-Time?:
Please Select
Full-Time
Part-Time
Name of School:
City and Country of Study:
Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
Course/Program Study:
Certified/ Degree Obtained:
Please Select
Secondary or Less
Non-University Certificate/Diploma
Post Secondary - No Degree
Post Graduate - No Degree
Bachelor's Degree
Master's Degree
Trade/Apprenticeship Certificate/Diploma
Number of Academic Years:
Did You Complete The Program?:
Please Select
Yes
No
Did You Receive an ECA ffor This Study? (If Yes, Please Attach the ECA):
Yes
No
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If your education was completed in Canada:
Did you complete at least 50% of the study or training program's courses through in-person learning?:
Yes
No
Did you study in Canada for at least 8 months in order to earn this degree, diploma or certificate?:
Yes
No
Did you study full-time for at least 8 months to earn this degree, diploma or certificate?:
Yes
No
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Section 7: Work Experience
(1)
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Name of Employer: (State if Self Employed)
Job Position Title:
Hours Per Week: (Approx.)
City and Country:
Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
(2)
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Name of Employer: (State if Self Employed)
Job Position Title:
Hours Per Week: (Approx.)
City and Country:
Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
(3)
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Name of Employer: (State if Self Employed)
Job Position Title:
Hours Per Week: (Approx.)
City and Country:
Address
Street Address
Street Address Line 2
City
State / Province
Postal Code
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Section 8: Job Offer in Canada
Job Title:
*
Employer/ Company Name:
*
Mailing Address of Company:
*
City:
*
Province:
*
Do You Currently Have a Valid Work Permit? (If Yes, Please Attach a Copy of Your Work Permit)
Yes
No
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Section 9: Port of Original Entry to Canada (If Applicable)
Date of Original Entry Into Canada:
Place of Original Entry Into Canada: (Port of Entry, City, Province)
Original Purpose of Coming Into Canada: (Work, Visitor, etc.):
Date and Place of Most Recent Entry to Canada: (If Not the Same as Original)
Date:
-
Month
-
Day
Year
Date
Place: (Port of Entry, City, Province)
Section 10: Proof of Funds
Amount of Money in Cash and/or Bank: (CAD/USD)
*
Please State Whether it's CAD or USD
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Section 11: Indicate Gaps Between Education and Employment History
(1)
Start Date:
-
Month
-
Day
Year
End Date:
-
Month
-
Day
Year
Please Describe What You Were Doing This Period (Eg. Looking for jobs, waiting for visas, taking care of children, school break, etc.):
City and Country Where Activity Took Place:
Status in Country:
(2)
Start Date:
-
Month
-
Day
Year
End Date:
-
Month
-
Day
Year
Please Describe What You Were Doing This Period (Eg. Looking for jobs, waiting for visas, taking care of children, school break, etc.):
City and Country Where Activity Took Place:
Status in Country:
(3)
Start Date:
-
Month
-
Day
Year
End Date:
-
Month
-
Day
Year
Please Describe What You Were Doing This Period (Eg. Looking for jobs, waiting for visas, taking care of children, school break, etc.):
City and Country Where Activity Took Place:
Status in Country:
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Section 12: Addresses Where You Lived For The Past 10 Years
Do Not Leave Any Gaps In Time
(1)
From:
-
Month
-
Day
Year
Start Date:
-
Month
-
Day
Year
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Province/ District:
Postal/ Zip Code:
(2)
From:
-
Month
-
Day
Year
To:
-
Month
-
Day
Year
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Province/ District:
Postal/ Zip Code:
(3)
From:
-
Month
-
Day
Year
To:
-
Month
-
Day
Year
Address:
Street Number
Street Name
Unit/Apt. #
State / Province
Postal / Zip Code
City of Residence:
Country of Residence:
Province/ District:
Postal/ Zip Code:
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Section 13: Previous Travel For The Past 10 Years
(1)
From:
-
Month
-
Day
Year
To:
-
Month
-
Day
Year
City:
Country:
Purpose of Travel: (Business, Visitor, Employment, Etc.)
(2)
From:
-
Month
-
Day
Year
To:
-
Month
-
Day
Year
City:
Country:
Purpose of Travel: (Business, Visitor, Employment, Etc.)
(3)
From:
-
Month
-
Day
Year
To:
-
Month
-
Day
Year
City:
Country:
Purpose of Travel: (Business, Visitor, Employment, Etc.)
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Section 14: Declaration Questions
Health Conditions:
*
*Please truthfully declare your health conditions. Misrepresentations will cause your file to be turned down.
Do you have a criminal record?
*
Yes
No
Have you ever been arrested, charged or convicted?
*
Yes
No
Applied for Canadian visa in the past?
*
Yes
No
Been refused a visa/entry into Canada?
*
Yes
No
Been requested to leave or deported from Canada?
*
Yes
No
Been refused a visa/entry into any other country?
*
Yes
No
If yes, please list the country:
Check All Visas Applied For In The Past:
Student Permit
Visitor Visa
Work Permit
Express Entry
Permanent Residency
Provincial Nominee Certificate
Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (Icluding non obligatory national service, reserve or volunteer units)?
Are you, or have you been a member or associated with any political party, or other group or organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time? Do not use abbreviations.
If you answered "yes" to any of the questions above, please provide an explantion. Please provide supporting documents as well.
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