Applicant Details
Your are applying for
Your Name
Your Name
First
Last
Preferred Language of Communication with Government of Canada
Have you taken a test from a designated testing agency to assess your proficiency in English or French?
Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.)?

Name History

Your Former Name
Your Former Name
Former First Name
Former Last Name
If you haven't already, please provide documents supporting this name change. Examples include marriage certificate, legal name change certificate etc.
During the past five years have you lived in any country other than your country of citizenship or your current country of residence for more than six months?

Past Countries of Residence

Spouse Details

Name of Your Spouse
Name of Your Spouse
First Name of Your Spouse
Last Name of Your Spouse
Is your spouse/common-law partner residing at the same address as you?
Address of Your Spouse
Address of Your Spouse
City
State/Province
Zip/Postal
Country
Is your spouse of common-law partner a Canadian citizen or permanent resident?
Employment Status of Your Spouse
Have you previously been married or in a common-law relationship?

Past Marital or Common Law History

Name of Past Spouse
Name of Past Spouse
First Name of Past Spouse
Last Name of Past Spouse
Spouse Deceased
Are you a lawful Permanent Resident of the United States with a valid alien registration card (green card)?
Have you come to Canada previously?

Coming into Canada

Have you had any post secondary education (including university, college or apprenticeship training)?

Post Secondary Education History

Please list all post secondary (after grade 12th or high school) degree, diploma, certificates etc.

Employment/Activity History

Give details of your employment/activity since the age of 18 or during the past 10 years, whichever is more recent, including if you have held any government positions (such as civil servant, judge, police officer, mayor, member of parliament, hospital administrator). Also list any period of unemployment and ensure you leave no time gaps.

Address History

Give details of your home address since the age of 18 or during the past 10 years, whichever is more recent. Please ensure you leave no time gaps.
Leave blank if ongoing
Address
Address
City
State/Province
Zip/Postal
Country
Do you have siblings - Brothers and Sisters (including half and step siblings)?

Siblings Details - Brothers and Sisters

Include all brothers and sisters, including half - and step-brothers and sisters.
Sibling Name
Sibling Name
First
Last
Employment Status of Your Sibling
Sibling Deceased
Sibling Living at Same Address as the Applicant
Sibling Address
Sibling Address
City
State/Province
Zip/Postal
Country
Do you have children (including step children)?

Children - Sons and Daughters

Include all sons and daughters, including all adopted and step children regardless of age and place of residence
Child's Name
Child's Name
First
Last
Employment Status of Your Child
Child Deceased
Child Living at Same Address as the Applicant
Child's Address
Child's Address
City
State/Province
Zip/Postal
Country

Mother or Parent 1

Mother's Name
Mother's Name
First
Last
Mother's Employment Status
Mother Deceased
Mother Living at Same Address as the Applicant
Mother's Address
Mother's Address
City
State/Province
Zip/Postal
Country

Father or Parent 2

Father's Name
Father's Name
First
Last
Father's Employment Status
Father Deceased
Father Living at Same Address as the Mother
Father's Address
Father's Address
City
State/Province
Zip/Postal
Country
Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?
Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?
Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?
Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory?
Have you previously applied to enter or remain in Canada?
Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country or territory?
Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve or volunteer units)?

Military Service Records

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 advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?

Organizations/Political Party - give the following details

Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?

Provide details - ill treatment of prisoners or civilians, looting or desecration of religious buildings

Have you ever held any government positions (such as civil servant, judge, police officer, mayor, member of parliament, hospital administrator)

Provide details - government positions

Do not use abbreviations
e.g. national, regional, municipal
Since the age of 18 or during the past 10 years, whichever is more recent, have you travelled to any country or territory other than the country of your citizenship or your current country of residence?

Previous Travels

Citizenship and Immigration Canada (CIC), or an organization at CIC' request, may want to contact you in the future to ask you about any services you received from CIC prior to the application process (such as participation in an information forum), during the application process (including the application process itself as well as orientation or accreditation services), and services received after arriving in Canada (including settlement, integration and citizenship). CIC will use this information , along with the information provided by other individuals, for research, performance measurement or evaluation purposes. CIC will not use this information to make any decisions about you personally .
Do you consent to be contacted by CIC, or an organization at CIC's request, in the future?
T&C