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T.!Inacio,!Registered!Canadian!Immigration!Consultant!
RCIC!Membership!#511568!
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Guide to Completing the IMM5257 Form (11-2015) E
Temporary Resident Visa as a Worker
1. UCI
Client ID (8-digit number listed in the box directly above the expiry date of your
study or work permit); or look for “UCI” number. xxxx-xxxx or xxxxxxxx
3. Visa requested
Visitor Visa
Personal Details
7. Current Country of Residence - Canada
Status
From (YYYY-MM-DD)
To (YYYY-MM-DD)
Worker
The date you became a worker; listed on your post graduate work permit
Your post graduate work permit expiry date
Language(s)
d) Have you taken a test from a designated testing
agency to assess your proficiency in English or
French?
Yes or No.
If you completed an IELTS, TOELF, CELPIP, other English/French language
test, indicated YES. If you completed an English/French Language School
program instead of an English/French test indicated NO.
Contact Information
1. Current mailing address
Apt/Unit
This is your apartment or room number. For example, 111 Edward St., Apt 201
2. Resident address, same as mailing address?
If your mailing address is where you reside or live, answer ‘Yes’.
Details of Visit to Canada
1. a) Purpose of my visit
Returning worker
2. Indicate how long you plan to stay
From (YYYY-MM-DD)
To (YYYY-MM-DD)
Date of your application ( today’s date)
Expiry date of your post graduate work permit
3. Funds available for my stay (CAD)
The amount indicated should be the same amount, or less, than the proof of
funds provided with your application.
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T.!Inacio,!Registered!Canadian!Immigration!Consultant!
RCIC!Membership!#511568!
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4. Name, address and relationship of any person(s) or
institution(s) I will visit:
Name
Relationship to me
Address in Canada
Employer Address if you are working.
If not please indicate Dalhousie University
PO Box 15000. Halifax, NS B3H 4R2
Relation: Former university
Education
1. Have you had any post-secondary education
(including university, college or apprenticeship
training)?
For Dalhousie students:
Answer ‘Yes” if you are a transfer or graduate student. Then enter your previous
college or university study information there. ESL school information can also be
put in here.
Answer ‘No’ if you came to Dalhousie directly from high school.
Employment
Under ‘Current occupation/Activity’, enter Student at Dalhousie University and
your university information.
Background Information
2. a) Have you ever remained beyond the validity of your
status, attended school without authorization or worked
without authorization in Canada?
b) Have you ever refused any kind of visa, admission, or
been ordered to leave Canada or any other country?
c) Have you previously applied to enter or remain in
Canada?
If you have studied or worked without a valid study or work permit, you will need
to provide details and explanation.
If you were ever refused any visa, admission to Canada or any other country
please indicate and briefly explain
Yes. List all visa/ permits previously applied for and when i.e. study permit
renewal, or co-op work permit or Temporary resident visa-Sept 2013.
Signature
This form cannot be printed, signed and scanned. You only need to validate and
save it to your desktop or on a USB and then upload online through MyCIC
