I. WARM UP

You are going to visit Canada. Before you plan your visit, you should find out if you need a visa to enter Canada. Complete the following application form. Share information with your partner.

PERSONAL DETAILS

1. Full name (family name and given name – as shown on your passport or travel document) ______

2. Have you ever used any other name (e. g. Nickname, maiden name, alias, etc.)? _____

3. Sex _____ 4. Date of birth (YYYY/MM/DD) _____

5. Place of birth (City/Town)_____ 6. Citizenship _____

7. Current country of residence: _____

8. Country where applying: (Same as current country of residence □ )_____

9. Your current marital status □ No □ Yes If you are married, provide the date on which you were married (YYYY-MM-DD) _____ Provide the name of your current Spouse (Family name, Given Name) _____

LANGUAGE(S)

1. Native language _____ 2. If your language not English or French, which language do you use most _____

PASSPORT

1. Passport number_____ 3. Country of issue_____

4. Issue date _____ 5. Expiry date_____

CONTACT INFORMATION

3. Current mailing address _____ 2. Telephon no. _____ 3. E-mail address _____

EDUCATION

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

2. If you answered “yes”, give full details of your highest level of post secondary education (from YYYY-MM to YYYY-MM, field, level, School/Facility name, City/Town, Country) _____

EMPLOYMENT

1. Give details of your employment for the past 10 years) (from YYYY-MM to YYYY-MM, Occupation, Company, City/Town, Country) _____

BACKGROUND INFORMATION

1. Within the past two years, have you or a family member ever had tuberculosis of lungs or been in close contact with a person with tuberculosis? □ No □ Yes

Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada? □ No □ Yes

2. Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada? □ No □ Yes

Have you ever been refused any kind of visa, admission, or been ordered to leave Canada or any other country? □ No □ Yes

3. Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country? □ No □ Yes

SIGNATURE OF APPLICANT _____ DATE (YYYY-MM-DD)_____

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XII. WORD LIST	\|	II. BEFORE YOU READ

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