CAQ-WORK 0506

Information on your identity

Have you applied CAQ work before?* Select No Yes

1.Full name*

2.Have you ever used any other name(e.g. Nickname, maiden name, alias, etc)?* No Yes

3.Sex* Female Male

4.Passport no.* (If you have more than one passport, provide the information on the passport you use to enter Canada, if applicable)

5.Your date of birth*

6.Place of birth*

7.Citizenship*

Home address

9.Current residential address*

10.Telephone no.

11.E-mail address

Please provide the following information for your spouse and all children (whether they are outside of Canada or already in Quebec):

Information on your Secondary and postsecondary studies

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

Information on your work experience related to the temporary employment offered in Québec

Indicate only relevant work experience for the temporary position offered in Québec. Work experience must have been acquired legally in full-time or part-time paid jobs.

1.

Period of employment:
from

To

Mains tasks accomplished

Stay in Quebec

You must declare your residence status in Quebec during the last five years. Check the box corresponding to your situation.

1.

Period of stay :
From

To

Your status of stay in Quebec Student permit Work permit Visitor record Others