IMM 0130 E : SCHEDULE 3 - Temporary Resident to …

1 (DISPONIBLE EN FRAN AIS - IMM 0130 F)PROTECTED WHEN COMPLETED - BPage 1 of 2 SCHEDULE 3 - Temporary Resident to Permanent Resident Pathway: Streams A & B and International GraduatesIMM 0130 (09-2021) EThe principal applicant must complete this form If there is not enough space to provide all the necessary information, attach to this form a separate sheet of paper with further details. Print your name at the top for each additional sheet and indicate the form's title and the number of the question you are 1: PERSONAL INFORMATION:Family Name: (As shown in your passport)Given Name(s): (As shown in your passport)ID/Client Number (if applicable):Date of Birth (YYYY-MM-DD):SECTION 2: PUBLIC POLICY STREAM SELECTION:To which public policy stream are you applying? (Select one)Workers in-Canada: Stream A (healthcare)Workers in-Canada: Stream B (essential non-healthcare)International GraduatesFrench-speaking Workers in-Canada: Stream A (healthcare)French-speaking Workers in-Canada: Stream B (essential, non-healthcare)French-speaking International GraduatesSECTION 3: LANGUAGE PROFICIENCY:Do you meet the minimum language requirements in the Canadian Language Benchmark (CLB) or the Niveaux de competence linguistique canadiens (NCLC) for listening, speaking, reading and writing based on the requirements of the stream to which you are applying?

2 Workers in-Canada: Stream A (healthcare) & Workers in-Canada: Stream B (essential non-healthcare)CLB/NCLC 4 (in either English or French)International GraduatesCLB/NCLC 5 (in either English or French)French-speaking Workers in-Canada: Stream A (healthcare) & French-speaking Workers in-Canada: Stream B (essential, non-healthcare)NCLC 4 (must be in French)French-speaking International GraduatesNCLC 5 (must be in French)Yes (provide language test) No (you should not apply)SECTION 4: CANADIAN EDUCATIONAL CREDENTIAL (if applying to the International Graduates Stream):Have you completed an eligible program of study after December 31st, 2016 at a Designated Learning Institution in Canada?YesNoSECTION 5: PAST CANADIAN WORK EXPERIENCE (Workers in-Canada streams (A & B) (French speaking and English):a) Do you have at least 12 months of authorized, full-time (or part-time equivalent) work experience in one or more eligible health-related occupations listed in Annex A or an essential eligible occupation listed in Annex B within the last 36 months?

3 YesNob) Starting with your current position, list all your positions within the three years preceding the date of your application. For each position, identify the dates of your employment, hours per week, your employer, the four digit National Occupational Classification (NOC) code, and your (YYYY-MM-DD)To (YYYY-MM-DD)Hours per weekEmployerNOCP osition/TitlePage 2 of 2 IMM 0130 (09-2021) ESECTION 6: CURRENT CANADIAN WORK EXPERIENCE (all streams):a) Are you currently physically present and working in Canada with valid work authorization and Temporary Resident status?YesNob) List your current position and identify the dates of your employment, hours per week, your employer, the four digit National Occupational Classification (NOC) code, and your (YYYY-MM-DD)To (YYYY-MM-DD)Hours per weekEmployerNOCP osition/TitleSECTION 7: DECLARATION OF APPLICANT:I declare that the information I have given is truthful, complete and (YYYY-MM-DD)Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection Act (IRPA).

4 The personal information will be used for the purpose of processing an application. The personal information provided may be disclosed to other federal government institutions and third parties for the purpose of validating information and eligibility. The personal information may also be disclosed to law enforcement bodies for the purpose of validating identity, eligibility and admissibility. The personal information may also be disclosed to provincial/territorial governments and foreign governments for the purpose of validating eligibility and admissibility. Personal information may also be used for other purposes including research, statistics, program and policy evaluation audit, compliance, program integrity, risk management, subsequent program eligibility, quality assurance, strategy development and reporting. Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction of their personal information.

5 If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC's Personal Information Bank - IRCC PPU 8: DISCLOSURE.