Express Entry Application/Profile details Names ‘Tell us Applicant Name name(s) exactly as shown in His Her passport, travel document or national identity document. LastName @ asl Firstname(s) @ as Tell us Applicants. personal details exactly as shown in Histher passport, travel ‘document or national Identity document. You can change your answers by ‘clicking the "Modify Family Information" button on the previous page. Gender Date of Birth @ TE (ese Month Country of Birth Sa City/Town of birth SSMartal status @ al Tellus about Appticant's passport or travel document. If HeiShe does hothave a passport or travel document, tell us about hisiher national identity document. Enter the detalls exactly as shown in the document. + Check the list at the bottom of the form first fo see information you have already saved + When you click “Save and Add”, each ID document will be saved to the list + The fields will go blank to let you add another ID document. + Use the modify er delete button If you want to change details that you have already saved to the list. Does Applicant have a passport or other travel document? Documenvi type @ Ed Document # (exactly as shown on the document) al Country of Issuance | Issue date @ year month ‘day Expiry date @ year Trent iH dayTellus about Applicant’ previous applications to Canada, countries of citizenship, and the country where he/she currently lives, Has Heishe applied to Citizenship and Immigration Canada before? Ca Countryles) of etzenship @ Country(ies) of citizenship aaa Country of residence @ Srl We need to know some information about Applicant's family. Tell us about histher family. How many family members does Appicant have? (This includes Pricipel Applicant ‘a spouse et partner, depenclent children, and thelr dependent children.) eset) ‘What funds (Canadian dollars) does Applicant have available to bring to Canada to support yourselt and his/her family? @ Sl a a |We need to know some information about ‘Applicant family. Tell us about histher family. Does Apptcant have a relative in Canada who is 18 years of age or older and Isa Canadian Citizen or Permanent Resident lving In Canada? @ Language of correspondence @ We will assess Applicant secondary and post-secondary periods of study fc eligibity for Exprass Entry, and use them to calculate Applicant's score. You ‘can tellus about each period of study by filing in the fields below. Check the list at the bottom of the form first to see Information you have already saved. + When you click "Save and Add”, each period of study will be saved to the list. + The fields will go blank to let you add details about another period of study. + Use the moulfy oF delete button if you want to change details that you have already saved to the list. Has Applicant finished high school or any higher education (Including university, college or vocational training)? YesNo U Field of study @ | IL Month [2s] Month ‘This Is my current study L Completo/tull academic years @ Cityltowm of study Fulltimefparttime study @ Name of schoolinsttution Standing at the end of study period @ Level of education @ eS Country of study Was applicant awarded a Canadian degree, diploma or certificate? @ (Le =a Signature, | Dates | alField of study @ | = HL Month ery Complete/tult academic years @ Cityntowm of study a [is Fulktimelpartsime study @ Name of sehoolinsttution [eae] SS Standing at the end of study period @ Level of education @ fo ee Country of study Was Applicant awarded a Canadian degree, diploma or certificate? @ ce emp saa Field ot study @ | From IL Month etn ~ [oo = Compltefful academic years @ Cityltovn of study | Fulttimelparttime study @ Namo of schootinsttution | Standing at the end of study period @ Level ot education @ ea Was Appicant awarded a Canadian degree, diploma or certiticate? @ Country of studyDoes Applicant has ECA report? ae ECA report equivalency | Canada's official languages ate English and French. Can Applicant communicate in English and/or French? @ Has Applicant taken a test from a designated testing agency to assess their proficiency in English? Yes! l Language test taken @ i Language test version @ | Date of language test @ Year Month Date HLDate of test results @ Month Date IIL Language test result form or certificate number ) Speaking Reading Listening writing Ea es ‘Which Provinees or Territories would Applicant consider ving in? F Aberta I ritish Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories, Nova Scotia Nunavut F ontario Prince Edvard Isiand Saskatchewan Yukon TT FF AllProvinces and Tenitories ‘The information contained in your Express Enty submission is collected by the Ontario Ministry of Citizenship, migration and International Trade (MCIIT) for use in connection ‘with your participation in Ontario Express Entry, By expressing an interest in Ontario, you authorise MCIIT to collect this information trom CIC, and for MCIIT to disclose this information to potential employers, as may be required in connection with your participation in Ontatio Express Entry. Questions about the collction may be directed to the Manager, Provincial Nominee Program at Opportunities. Ontario@ontario.ca ‘mailto: Opportunities. Ontario@ontatlo.c ‘Ontario LC]Has ‘applicant received a nomination certificate from a province or territory? ES] Provide an emall address below where correspondence can be sent. Correspondance willbe sent to your MyCIC account. However, we may need to send correspondence by emall, Indicating an email address wall authorize ‘correspondence, including fle and personal information, to be sent to this emall address, when needed, Emailadaress @ | Primary occupation (4 digit NOC Code) | Date Applicants first became qualified to practice in this occupation Year I Doos Applicant have a certificate of qualification trom a Canadian province or teritor? @ Yesito U Does Applicam have a job offer in Canada? YesiNo U We will assess Applicants's current and previous jobs for eligbliy for Express Entry, and use them to calculate Applicante score. You can tell us about each job by filing in the fields below. Do not enter any work related to or performed during an apprenticeship process. Check the list at the bottom of the form first to see information you have already saved. + When you click "Save and Add’, each job will be saved to the list. + The fields will go blank to let you add another job. + Use the modify or delete button if you want to change a job that you have already saved to the list Does Applicant have any work history? Yesito U From Year Month il 1 this s mycurentjobMonth pees] Hours per week St Four digit NOC code @ | Job title | Employericompany name | 11 satt-empioyed work Country | City/Town, | payFrom Month i 1 This is my current job Year Monty i Hours per week i Four digit NOC code @ | Job title | Employer/company name 1 Self-employed work country City/Town, | | Signature payFrom Month i 11 This is my current job Year Month UL Hours per week i Four digit Noc code @ | Job title | Employer/company name 1 Self-employed work country City/Town, pay