Express Entry Form

Express entry questionnaire

To be filled out after reciving ITA
- Complete Name*
  
  NameLast Names
- Have you ever used any other name?*
- Eye colour*
- Please enter your height in: (1) centimetres (cm)*
- Telephone number*
  
  Código de áreaNúmero de teléfono
- Telephone type*
- Email
  ejemplo@ejemplo.com
- In which province do you intend to reside?*
- In which city/town do you intend to reside?*
- Provide all of the addresses where you have lived in the past ten years or since your 18th birthday, whichever is most recent.
  
  Start with the most recent information.
  
  Note: Please ensure that you do not leave any gaps in time.
- Address History
- Provide the details of your personal history in the last ten years (or since your18th birthday if this was less than ten years ago).
  Start with the most recent information.
  Note: Please ensure that you do not leave any gaps in time.
- Personal Activities
- Provide details of any trips you have taken outside your country of origin or of residence in the last ten years (or since your 18th birthday if this was less than ten years ago). Include all trips: tourism, business, training, etc.
  Start with the most recent information.
- Travel History
- Have you been convicted of a crime or offence in Canada for which a pardon has not been granted under the Criminal Records Act of Canada? (required)*
- Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country*
- Have you made previous claims for refugee protection in Canada or at a Canadian visa office abroad, in any other country or countries, or with the United Nations High Commissioner for Refugees (UNHCR)?*
- Have you been refused refugee status, or an immigrant or permanent resident visa (including a Certificat de sélection du Québec (CSQ) or application to the Provincial nominee Program) or visitor or temporary resident visa, to Canada or any other*
- Explain your situation *
- Have you been ever been refused a visa or permit, denied entry or ordered to leave Canada or ANY OTHER country?:*
- Explain your situation *
- Have you been involved in an act of genocide, a war crime or in the commission of a crime against humanity?:*
- Have you used, planned or advocated the use of armed struggle or violence to reach political, religious or social objectives?:*
- Have you been associated with a group that used, uses, advocated or advocates the use of armed struggle or violence to reach political, religious or social objectives?*
- Have you been a member of an organization that is or was engaged in an activity that is part of a pattern of criminal activity?*
- Have you been detained, incarcerated, or put in jail?iminal activity?*
- Have you had any serious disease or physical or mental disorder?*
- Should be Empty:

Express entry questionnaire