Personal History Name(Required) First Last PhoneEmail(Required) Your Current Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Please provide information about your personal history for the last 10 years, starting with your current activity and working your way down the table. No period of time can be omitted. Start Date End Date Activity Location Name of Employer, School, or Organization Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Do you have secondary school or higher education?(Required) Yes No Please list your secondary school and higher education Start Date End Date Field of Study Location Name of School Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you previously served in the Military?(Required) Yes No Please provide more details about your Military Service Start Date End Date Location Division of Military Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Current Marital Status(Required)SingleMarriedDivorcedWidowedSeparatedDomestic PartnershipHave you previously been married or in a common-law partnership?(Required) Yes No In the immigration context, a common-law partnership means that a couple have lived together for at least one year in a conjugal relationship.Marital Status History From Until Name of Spouse Spouse’s Date of Birth Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you ever entered Canada?(Required) Yes No Please provide the dates of your entries to Canada. Date of Entry Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you ever extended your stay in Canada?(Required) Yes No Please provide the dates when you applied for extensions. Date of Application for Extension Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you ever remained in Canada without status?(Required) Yes No Please provide the dates Date Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you ever been refused a visitor record, visa, permit or denied entry to, or ordered to leave Canada or any other country?(Required) Yes No Please provide the dates and reasons Date Reason Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country/territory?(Required) Yes No Please provide the dates and reasons Date Reason Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Do you have a serious health condition for which you are receiving regular medical treatment?(Required) Yes No Please provide details(Required)
