Immigration Canada

Immigration Questionnaire

Data collection document required from the principal applicant. Please complete all mandatory fields.

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Identification SectionPrincipal Applicant

Birth Last Name

First Name

Date of Birth

Phone

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Required DocumentsDocuments to Provide

Please provide a copy of the following documents:

Passport and a copy of each page bearing a stamp from any country visited
Copy of any visa / study or work permit already obtained for Canada
CV and copies of diplomas
Birth certificate and marriage certificate, if applicable
Birth certificates of dependent children, if applicable

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Section AGeneral Questions

Current address and status in Canada

Dates of previous trips to Canada

Last date of entry into Canada and location

Marital Status

Marital status

Date of marriage or start of union

Previously married / common-law partner?

Full name of previous spouse/partner

Date of birth — previous spouse/partner

Start of relationship

End of relationship

Yes / No Questions

Answer "Yes" or "No" — if "Yes", provide details in the details field.

In the last ten (10) years, have you provided biometric data to enter Canada?

In the last twelve (12) months, have you undergone a medical examination recognized by Immigration Canada?

In recent years, have you or any member of your family had tuberculosis or been in close contact with someone who has?

Do you have a physical or mental condition that would require social/medical services other than medication during your stay in Canada?

Have you remained in Canada after the expiry of your status, attended school without a study permit, or worked without a work permit?

Have you ever been refused a visa or permit, been denied entry, or asked to leave Canada or any other country?

Have you ever applied to enter or remain in Canada?

Have you ever committed, been arrested, charged, or found guilty of any criminal offence in any country?

Have you ever been part of an army, militia, civil defence unit, intelligence service, or police force, or served in the military?

Are you, or have you ever been, a member of or affiliated with a political party or group that has used violence for political or religious purposes?

Have you witnessed or participated in the mistreatment of prisoners or civilians?

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Section B — TableEducation History

Please list all post-secondary studies.

Entry 1

From (month-year)

To (month-year)

School name

City / Country

Diploma type

Field of study

Entry 2

From (month-year)

To (month-year)

School name

City / Country

Diploma type

Field of study

Entry 3

From (month-year)

To (month-year)

School name

City / Country

Diploma type

Field of study

Entry 4

From (month-year)

To (month-year)

School name

City / Country

Diploma type

Field of study

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Section B — TableEmployment History

List the last 10 years of employment (including unemployment, studies, travel). Start with current situation.

Job 1 (current)

From (YY/MM)

To (YY/MM)

Employer / Institution

Title / Occupation

City

Country

Reason for leaving

Job 2

From (YY/MM)

To (YY/MM)

Employer / Institution

Title / Occupation

City

Country

Reason for leaving

Job 3

From (YY/MM)

To (YY/MM)

Employer / Institution

Title / Occupation

City

Country

Reason for leaving

Job 4

From (YY/MM)

To (YY/MM)

Employer / Institution

Title / Occupation

City

Country

Reason for leaving

Job 5

From (YY/MM)

To (YY/MM)

Employer / Institution

Title / Occupation

City

Country

Reason for leaving

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Section B — TableAddress History

List all addresses for the last 10 years.

Address 1 (current)

From (YY/MM)

To (YY/MM)

Address

Province / Country

Postal code

Address 2

From (YY/MM)

To (YY/MM)

Address

Province / Country

Postal code

Address 3

From (YY/MM)

To (YY/MM)

Address

Province / Country

Postal code

Address 4

From (YY/MM)

To (YY/MM)

Address

Province / Country

Postal code

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Section B — TableImmediate Family

To include: husband/wife/partner, mother and father, child(ren), brother(s)/sister(s). If a member is deceased, indicate the date and city of death.

Member 1

Last Name / First Name

Relationship

Date of birth

Country of birth

Marital status

Current employment

Address and email

Member 2

Last Name / First Name

Relationship

Date of birth

Country of birth

Marital status

Current employment

Address and email

Member 3

Last Name / First Name

Relationship

Date of birth

Country of birth

Marital status

Current employment

Address and email

Member 4

Last Name / First Name

Relationship

Date of birth

Country of birth

Marital status

Current employment

Address and email

Member 5

Last Name / First Name

Relationship

Date of birth

Country of birth

Marital status

Current employment

Address and email

Member 6

Last Name / First Name

Relationship

Date of birth

Country of birth

Marital status

Current employment

Address and email

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ConfirmationAttestation and Signature

⚠️ Notice: By completing and returning this document, the principal applicant confirms that the information disclosed and submitted is accurate and truthful.

Signature date

I attest that all information above is accurate and truthful, and I understand that any misrepresentation may result in the refusal or cancellation of my immigration application.

Your information is transmitted securely to the BJ Immigration team.