Visa/Work Permit Application - Step 3


1. Personal Information Note: Information entered on this questionnaire may be shared with your company's HR Department or audit team if requested. If you are on certain IBM assignment plans, some of this information may also need to be shared with IBM's accounting firm for tax purposes.

First Name:
Middle Name(s):
Last Name (Surname):	*
Gender:	* Not Specified Male Female
The above must be exactly as shown in your passport

Marital Status:	*
Native Language:	*
Maiden or Other Names used (Include names from all previous marriages)
Current Resume(CV)	*
Professional Organisations belonged to (such as an Engineering or PMP Association)

2. Current Contact Information

Current Home Address:

City:

State / Prov:

Postal Code:

Country:

Home Phone:

Current Company Name:

Current Company Address:

City:

State / Prov:

Postal Code:

Country:

Company Phone:

Preferred Email Address:

IBM India Employees Only

Select closest IBM Travel Ops location to ship package to:

3. Employment Status

Your present job title:

Job title in new location if different:

Detailed description of your current business responsibilities, listing specific duties for the past seven years. Job titles alone are not sufficient.
(If your resume is detailed you may skip this question)

Original hire date with IBM
(or subsidiary):

Will you be returning to your home country following this work?

Unknown No Yes

Who will be paying you while you are on this assignment?

It is required that we provide the Government of Canada with your annual salary. If your salary will be different in Canada, please provide that, otherwise use your current salary.

Annual Salary with currency (or Band Level if HCCM from India)

Your IBM Business Unit:

Home IBM Serial #:

Canadian IBM Serial # (if issued):

Employment Status:

Home Manager's Name:

Home Manager's Phone:


4. Your Education:

Note: The following information must be exactly as shown on your diploma
Qualification 1:
School 1:
Graduated 1 (YYYY):
Qualification 2:
School 2:
Graduated 2 (YYYY):
Qualification 3:
School 3:
Graduated 3 (YYYY):
Qualification 4:
School 4:
Graduated 4 (YYYY):


5. Legal Status:

Date of Birth:	*
Place, Province and Country of Birth:	*
Citizenship:	*

Passport Number:	*
Passport date issued:	*
Passport date expires:	*
Attach scan of picture page from passport.	**

Canadian Permanent Resident card holder:	* Unknown No Yes
US Green Card holder:	* Unknown No Yes


6. Previous Visits to Canada

If you have previously worked in Canada, please provide the number of days you were in Canada in:
2009:
2010:
2011:
If you have previously worked in Canada since January 1, 2009, please attach a scan of a calendar, or a spread sheet, showing your previous entry dates into, and departures from, Canada.
Summary File


7. Work Permit Extensions

If this is a request for an extension, or if you are applying for a second permit:

Canadian Government Client ID # :
(This is the 8 digit Client ID number found in box on current or previous Work Permit/Visitor Record)

Please provide date, city and province where you FIRST entered Canada:
Date:
City / Province:

Please provide date, city and province where you MOST RECENTLY entered Canada:
Date:
City / Province:

If you had a medical, please give:
Date:
Scanned Receipt:


8. Desired Work Visa or Permit:

Type of document needed:	*
Entry Date:	*
Number of months required:	*
Location of Entry:	*
*Note: Immigration documentation and procedures may vary by port of entry - if your port of entry changes after you submit this application, please let us know.

New IBM Location Address:	*
Client Name(s) & Address(es):	*
IBM Canada Manager at New Location:	*
Job Description: (Provide detailed information such as applications or programs you will be working on, your job responsibilities and specific duties, etc. - 50 -100 words minimum)
*
Required Special Skills:	*


11. Service Options

Service Required:	* $
Order Processing (Mandatory)	$

12. Payment Details

Shipping:

Fees:

Net Cost

Tax Total

Total Cost (CAD)

Billing / Shipping Address:

Billing Address:

Billing City:

Billing State / Prov:

Billing Postal Code:

Billing Country:

Contact Telephone:

I am paying by:

Cardholder Name:

Card Number:

Expiry Month / Year: