IMM 1295: Application for Work Permit Made Outside of Canada

In 1 Full name, enter the family name and the given name(s) as shown on your passport or travel document.

Mark No or Yes for: Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.)?

Mark No or Yes for 8 Previous countries or territories of residence: during the past five years, have you lived in any country or territory other than your country of citizenship or your current country or territory of residence for more than six months?

Mark No or Yes for 9 Country or territory where applying: Same as current country or territory of residence?

If you are married or in a common-law relationship, provide the date on which you were married or entered into the common-law relationship.

Provide the name of your current Spouse/Common-law partner: Family name and Given name(s).

Mark No or Yes for 11: Have you previously been married or in a common-law relationship? Provide details for your previous Spouse/Common-law Partner: Family name, Given name(s), Date of birth, Type of relationship, From and To.

Mark No or Yes for d) Have you taken a test from a designated testing agency to assess your proficiency in English or French?

Fill in Passport number, Country or territory of issue, Issue date and Expiry date (YYYY-MM-DD).

Mark No or Yes: Do you have a national identity document?

Mark No or Yes: Are you a lawful permanent resident of the United States?

If submitting your application by mail, all correspondence will go to the address in this section unless you indicate your e-mail address. Indicating an e-mail address will authorize all correspondence, including file and personal information, to be sent to the e-mail address you specify. If you wish to authorize the release of information from your application to a representative, indicate their e-mail and mailing address(es) in this section and on the IMM5476 form.

Mark No or Yes for Residential address: Same as mailing address?

Under 2 Details of my prospective employer, attach original offer of employment.

In a) Name of Employer, if you are employed by a foreign employer who has been awarded a contract to provide services to a Canadian entity, please identify the foreign employer.

Mark No or Yes: Have you had any post secondary education (including university, college or apprenticeship training)?

If you answered yes, give full details of your highest level of post secondary education.

Give details of your employment for the past 10 years, including if you have held any government positions (such as civil servant, judge, police officer, mayor, member of parliament, hospital administrator).

You must complete this section if you are 18 years of age or older.

Mark No or Yes for 1 a) 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?

Mark No or Yes for b) Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?

If you answered yes to question 1a) or 1b), please provide details and the name of the family member (if applicable).

Mark No or Yes for 2 a) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?

Mark No or Yes for b) Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory?

Mark No or Yes for c) Have you previously applied to enter or remain in Canada?

If you answered yes to question 2a), 2b), or 2c) please provide details.

Mark No or Yes for 3 a) Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country or territory?

If you answered yes to question 3a), please provide details.

Mark No or Yes for 4 a) 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)?

If you answered yes to question 4a), please provide dates of service and countries or territories where you served.

Mark No or Yes for 5 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?

Mark No or Yes for 6 Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?

If you answered yes to any of questions 3 to 6, or upon request of a visa officer, you MAY BE REQUIRED to fill out IMM 5257 Schedule 1.

Mark No or Yes: Do you consent to be contacted by IRCC, or an organization at IRCC's request, in the future?

The form prints this declaration: "I declare that I have answered all questions in this application fully and truthfully."

This application must be signed and dated before it is submitted by mail.

Do not forget to include photos, fees (if applicable) and any other documents required.