Information Needed

1- Educational History (After High School) List all the colleges and field of study
Name of Institution
From- YYYY-MM
To- YYYY-MM
Level of Study-
Field of Study-
Institution’s Address-
For multiple colleges, please write all the details required for all colleges.

2- Employment History of last 10 years (Write all the details of every job you have worked
in past 10 years)
From- YYYY-MM
To-YYYY-MM
Work/Activity-
Job Title-
Company/Employer-
Main duties of the job-
Address

For multiple jobs, please write all the details required for all jobs.

3- Travel History of past 5 years

If yes,
FROM- YYYY-MM
To-YYYY-MM
Country-
Location (City)-
Purpose of Travel-

YES/NO QUESTIONS- PLEASE ANSWER ALL QUESTION IN YES/NO FORMAT

4- * Have you ever been refused a visa or permit, denied

entry to, or ordered to leave any country or territory?

5- Have you ever committed any crime in any country or territory (this
includes driving under the influence of alcohol or drugs)?
 6- * Have you ever been arrested for any criminal offence in any country
or territory (this includes driving under the influence of alcohol or
drugs)?
7- * Have you ever been charged for any criminal offence in any country or
territory (this includes driving under the influence of alcohol or
drugs)?

8- * Have you ever been convicted for any criminal offence in any country
or territory (this includes driving under the influence of alcohol or
drugs)?

9- * Are you or have you ever been a member or associated with any
political party, or other group or organization which has engaged in or
advanced violence as a means to achieving a political or religious
objective, or which has been associated with criminal activity at any
time?

10-* Have you ever witnessed or participated in the ill treatment of

prisoners or civilians, looting or desecration of religious buildings?
In the last 2 years, were you diagnosed with tuberculosis?

 Tuberculosis is a disease of the lungs caused by bacteria. It may also be

known as TB, Potts disease, Koch's disease, scrofula, latent tuberculosis or
extra-pulmonary tuberculosis.
 If you have a history of tuberculosis, it doesn't mean that you can't come to
Canada. Once you complete your treatment, you can come to Canada.

11-* In the last 5 years, have you been in close contact with a person with
tuberculosis?

 Tuberculosis is a disease of the lungs caused by bacteria. It may also be

known as TB, Potts disease, Koch's disease, scrofula, latent tuberculosis or
extra-pulmonary tuberculosis.
 If you have a history of tuberculosis, it doesn't mean that you can't come to
Canada. Once you complete your treatment, you can come to Canada.

12-Are you currently receiving dialysis treatment?

13- Have you had a drug or alcohol addiction causing you to be a threat to
yourself or others, or to be hospitalized?

14- Have you had a mental health condition causing you to be a threat to
yourself or others, or to be hospitalized?

15-Have you ever been diagnosed with syphilis?

 Syphilis is a disease caused by bacteria and may also be known as lues, syph
or pox.
 If you have a history of syphilis, it doesn't mean that you can't come to
Canada. Once you complete your treatment, you can come to Canada

16- Are you married?

If yes, please provide following details:

Date of Marriage:

Full Name of Spouse:

DOB of Spouse:

Country of your spouse’s birth:

Present Occupation:

Is her address same as yours?

17- Do you have Children? If yes, please provide following details of all childr:

Full Name-

DOB-

Country of Birth-

Does this child have the same address as you? If no, please provide their address.

18- Provide the details of your parents.

Full Name-

DOB- If he/she has passed away, please provide the date of death.

Country of Birth-

Present Occupation-

Address-