INFORMATION FORM
Basic Information:
What is your full name (as seen on passport)? What are your contact phone numbers? (Home and other)
Family Name:
Given Name:
What is your date of birth DD/MM/YYYY? What is your email address?
Place of birth? Town/City and Country What is your residential address?
Gender: Male/Female How long have you been at this address?
Height Eye Color How many years of formal education do you have?
Circle your marital status? Circle the highest completed level of
• Never Married education.
• Married Please put a number beside the amount of years spent
• Widowed
in each level.
• Legally separated
• No Secondary
• Annulled marriage
• Secondary
• Divorced
• Trade/ Apprenticeship
• Common law
• Non-university certificate diploma • Bachelor
Do you have any children? Yes OR Degree
No If so, how many? • Masters
• PhD
Do you have any family members in Canada? Yes OR No
Country(ies) of citizenship: What country are you currently residing in?
From(YY/MM/DD):
To(YY/MM/DD):
What was your marriage/common law start date? What status do you hold in the country that you reside
DD/MM/YYYY in?
(ie. Citizen, temporary foreign worker...)
What is your native language(s)? Have you taken a test from a designated agency to assess
your proficiency in English or French? Yes/No
What language of correspondence do you prefer? English The amount of funds you have available in Canadian
dollars?
or Other(Native)
What is your passport number? What country issued your passport?
Issue and Expiry date:
Have you ever used any other names? Last date of Entry into
if yes please answer following: Canada(air or Land) City:
Last Name: Province:
First Name: Date:
Current Occupation: Intended Occupation:
Do you have any relatives in Saskatchewan? If yes, please provide the following details of the relative: First Name:
Last Name:
Mailing Address:
Email:
Contact no:
Relationship:
Length of residence in Canada:
Length of residence in Saskatchewan:
If yes please provide the following :
Have you Lived In any Other Country Besides Your
Country:
Country of citizenship, or your current country of
residence?
Status:
Yes or No
Worker ( ) Student( ) Visitor( )
From(date):
(DD/MM/YYYY)
TO (expiry date on permit):
(DD/MM/YYYY)
Were you previously married or in a common-Law relationship?
Yes( ) or No( )
If yes please answer the following:
Former Spouse Last Name:
Former Spouse First Name:
Type of relationship: Married( ) or Common-Law( )
Date of relationship:
From:
(DD/MM/YYYY)
To:
(DD/MM/YYYY)
Education Details:
From To Institution Name Field of Study Type of City
(YYYY/MM/DD) (YYYY/M/DD) Certificate or and Country
Diploma Issued
Personal History: Provide the details of your personal history since the age of 18 or the past 10 years, whichever is most
recent.
From To Activity City/Town and Status in Name of company,
YYYY/MM YYYY/MM Country Country employer, etc
Present
Previous Address (es): Provide the details of your previous address since the age of 18 or the past 10 years, whichever is
most recent.
From To Street and City/ Province,State Or Postal Country
YYYY/MM YYYY/MM Number Town district Code/
ZipCode
Present
Family Member Breakdown Chart: (Must include Mother, Father, Spouse, Brothers, Sisters, Spouse, Children,
Stepchildren, and Step-siblings)
First Family Relation Date of Place of Gender Marital Current Occupation EmailAddress
Name Name ship Birth Birth M/F Status Address
(Surname) DD/ (Town/City & (If
MM/YY Country) decease
d, put
decease
d date)
Spouse
Father
Family name Mother
at
birth:
Travel History: List all your trips in the last 10 years or since your 18th birthday if this was less than 10 years ago
From To Length Destination Purpose of travel Status in country
YYYY/MM/DD YYYY/MM/DD (City, Town)
Names of those accompanying you to Canada:
(Only Spouse and dependent children can be named below)
Full Name Relationship Height Eye Passport Passport Highest
to You cm or Color Number Issue & Level of
inches Expiry Date Education Completed
DD/MM/
YYY
Government Positions:
List any government positions (i.e. Civil Servant, Judge, Police officer, etc.)you have held if you have not held any government
positions, write "None"
Job title, Activity/Position Held Department/ Country & From To
Branch, You Jurisdiction Level DD/MM/YYY DD/MM/YYY
Worked (national, regional, etc.)
Military Service:
List any Military positions you have held if you have not held any Military positions, write "None”
From To Branch of service, units Rank Dates and Reason for end
YYYY/MM YYYY/MM numbers and names of your places of any of service
commanding officers active
combat
Membership or Association with Organizations:
From To Name of Organization Activity/ Type of City
(YYYY/MM) (YYYY/MM) Positions Organization and Country
Held
Have you, your spouse, or dependent child (18-22 years of age) ever been:
1. Been convicted of a crime in Canada? Yes / No
2. Been convicted of, or are currently charged with, on trial in Canada? Yes / No
3. Made previous claims for refugee protection in Canada or other countries? Yes / No
4. Been refused admission to or ordered to leave Canada or any other country? Yes / No
5. Been involved in act of genocide, a war crime or in the commission of a crime against Humanity? Yes / No
6. Used, planned or advocated the use of armed struggle or violence to reach political, religious or social objectives?
Yes/No
7. Been or is associated with a political group that used/uses violence for political gain? Yes / No
8. Been a member of an organization that is or was engaged in an activity that is a part of a pattern of a criminal activity? Yes/No
9. Been detained, incarcerated or put in jail? Yes / No
10. Had any serious disease or physical or mental disorder? Yes/No
Notes: Signature:
