LMIA First Name of employee* Last Name of employee* SECTION 1: BUSINESS INFORMATION 1.Canada Revenue Agency Payroll deductions program account number (15 digits)*: 2.Business Legal Name (as registered with CRA)*: 3.Business Address (as registered with CRA)* 4.City* 5.Province* 6.Country* 7.Postal/Zip Code*: 8. Quebec enterprise number (NEQ)* 13.Website Address: 14.Date the company has been operating in Quebec: 15.Organization type and structure (select all that apply): Sole proprietor Partnership Corporation Co-operative Non-profit Registered Charity SECTION 2: EMPLOYER CONTACT INFORMATION PRINCIPAL EMPLOYER CONTACT INFORMATION (This person must be the employer or be an employee of the employer) 1.First Name* Middle Name Last Name* 2.Job Title*: 3.Sex* Female Male 4.Date of birth* 5.Telephone Number*: 6.other Telephone Number: 7.Fax Number 8.Email Address*: 9.Email Preference: Do not contact via email 10.Language of Correspondence*: English French 11.Mailing Address*: ALTERNATE EMPLOYER CONTACT INFORMATION (This person must be the employer or be an employee of the employer) 12.First Name Middle Name: Last Name: 13.Job Title: 14.Telephone Number: 15.Other Telephone Number: 16.Fax Number 17.Email Address: 19.Email Preference: Do not contact via email 19.Language of Correspondence: English French 20. Mailing Address: SECTION 4: LABOUR MARKET IMPACTS 1. How many employees are employed nationally under the employer’s 9 digit CRA business number?* 2. Did the business report more than $5 million (CAD) in annual gross revenue to CRA during its last tax year?* No Yes 3. Will hiring a TFW result in direct job creation or job retention of Canadians/permanent residents? No Yes 4.provide details: 5. Will hiring a TFW result in the development or transfer of skills and knowledge for the benefit of Canadians/permanent residents? No Yes 6.provide details: 7.Will hiring a TFW fill a labour shortage? No Yes 8.provide details: 9.Please describe any other benefits to the Canadian labour market that will result from offering this job to a TFW: 14. Does the business receive support through Employment and Social Development Canada/Service Canada’s Work-Sharing program?* No Yes 15.provide details: 16. Is there a labour dispute in progress at any of the job offer work locations?* No Yes 17.provide details: SECTION 5: JOB OFFER DETAILS 2. What is the job title of the position being offered to the TFW(s)*: 3. Describe, in your own words and in as much detail as possible, the main duties of the position offered to the TFW(s): 4. How is the position requested in this application necessary for the operations of the business and explain the impact on your operations should the position remain vacant? Description of tasks Percentage of time granted 5.What is the expected employment start date? 6.What is the expected employment duration?* years months 7. Please justify the requested employment duration in accordance with the planned activities or projects within your organization 8. Indicate the language requirement stated in the offer of employment: Does this position not require the ability to communicate in any language? Yes No This position requires the ability to communicate orally in: English French English or French English and French This position requires the ability to communicate in writing in: English French English or French English and French Does the position require the ability to communicate in a language other than English or French? No Yes 9. Minimum education requirements of the job: No formal education requirement Completion of secondary school Apprenticeship, trade or vocational diploma or certificate College level diploma/certifica Professional degree Bachelor’s degree Master’s degree Doctorate/Ph.D. Doctor of Medicine Other minimum education requirements Not specified by employer Describe the specific diploma/certificate, degree, Ph.D. or other education requirements that the job requires: 10. Minimum experience/skills requirements of the job (include years of experience and/or occupational designations such as CPA, RN, P.Eng.): 11. Is the occupation regulated at a federal/provincial/territorial level and requires occupational certification, licensing, or registration?* No Yes please indicate the type of occupational certification, licensing, or registration and the name of the issuing body/ authority: 12. Have you failed to comply with the conditions relating to a temporary or permanent job offer?* No Yes please identify the job offer(s), their date and provide the justification: 13. After entering into an employment contract with a foreign national who was the subject of a temporary or permanent job offer, did you amend this employment contract or enter into another employment contract, in writing or orally ? No Yes please identify the job offer(s), its date and indicate what has been modified or added or removed by the amendment or the new employment contract: SECTION 6: WORK LOCATION 1. Business Operating Name of the primary work location* 2. Describe, in your own words and in as much detail as possible, the principal business activity at the primary work location*: 3. Describe, in your own words and in as much detail as possible, any safety concerns or hazards associated with the principal business activity or site: 4. Address of the primary location where the TFW will work*: SECTION 7: HOURS, PAY AND BENEFITS 1. Are there employees currently working in this occupation, with the same skills and years of experience, at this work locations?* Yes No What is the wage range for all employees currently working in this same occupation, with the same skills and years of experience, at this work location?(Note: The wage range should be from the last 2 pay periods that have occurred within the 6 weeks prior to submitting the application.) 2.How many hours will the TFW work each day?* 3.How many hours will the TFW work each week?* 4. Will the TFW have a schedule with standard daily or weekly hours?* Yes No if yes, the working day starts at* The working day ends at* 5.if the TFW will have an atypical schedule without standard daily or weekly hours,please provide details*: 6.How many days off per week THE EMPLOYEE is entitled to?* 7. Is the employer’s job offer for a full- time position (average of al least 30 hours per week) throughout the duration of employment covered by this LMIA? No Yes 8. please provide details: 9. What is the regular (non-overtime) wage in Canadian dollars per hour being offered to the TFW?* 10. What is the overtime wage in Canadian dollars per hour being offered to the TFW? (if applicable and must meet provincial/territorial requirements)* 11.His salary will be paid to him at an interval of* 12. Will the TFW be paid any contingent wages (e.g. piecework, mileage, commissions, guaranteed bonuses, or predictable overtime)?* No Yes 13. please provide details: 14.Is the position part of a union?* No Yes please attach the section(s) of the collective bargaining agreement that list rates of pay_ 15. Benefits (additional benefits offered over and beyond the provincial/territorial requirements): Disability insurance Dental insurance Employer-provided Pension Extended medical insurance (e.g. prescription drugs, paramedical services, medical services and equipment) Others SECTION 8: RECRUITMENT 2. Did the employer try to recruit Canadians/permanent residents prior to submitting this LMIA application for this job?(Note: Most program streams require recruitment efforts within the 3 months prior to submitting an application. ) No Yes please explain why the employer has not attempted to recruit Canadians/permanent residents: please complete all the applicable boxes and provide the required information below (Proof of recruitment must be submitted with the LMIA application, i.e. copy of advertisements and information to support where, when and for how long the position was advertised). Method Name of Advertising Source Website Address (if applicable) Advertisement # Publication Date Expiry Date If you have other methods, please click the button ADD. 3. How many applications/resumes were received from Canadians/permanent residents? 4. How many Canadians/permanent resident applicants were interviewed? 5. How many Canadians/permanent residents were offered the position? 6. How many Canadians/permanent residents were hired? 7. How many Canadians/permanent residents declined a job offer? 8. How many Canadians/permanent residents applied but were not interviewed or offered the position?
