Contact Person Name*

Address*

City*

State / Province*

Country*

Zip / Postal Code

Fixed Phone Number(s)*

Mobile Number(s)

Fax Number(s)

Email ID

Factor 1 – Education (maximum 25 points)

Indicate your highest level of education

Did not complete secondary school (also called high school)
Obtained a secondary school credential
Obtained a one-year diploma, trade certificate or apprenticeship and completed at least 12 years of full-time or full-time equivalent studies
Obtained a one-year diploma, trade certificate or apprenticeship and completed at least 13 years of full-time or full-time equivalent studies
Obtained a one-year university degree at the bachelor’s level and completed at least 13 years of full-time or full-time equivalent studies
Obtained a two-year diploma, trade certificate or apprenticeship and completed at least 14 years of full-time or full-time equivalent studies
Obtained a university degree of two years or more at the bachelor’s level and completed at least 14 years of full-time or full-time equivalent studies
Obtained a three-year diploma, trade certificate or apprenticeship (other than university) and completed at least 15 years of full-time or full-time equivalent studies
Obtained two or more university degrees at the bachelor’s level and completed at least 15 years of full-time or full-time equivalent studies
Obtained a master’s or Ph.D. and completed at least 17 years of full-time education or full-time equivalent studies

Factor 2 – English and French language ability (maximum 24 points)

To assess your English and French ability, first decide which language you are most comfortable with. This language is your first official language. The language you feel less comfortable communicating in is your second official language.

Determine your language ability, then award points according to your ability to read, write, listen to and speak English and French.

Check the areas that reflect your ability to read, write, listen to and speak English and French.

First Canadian Official Language (either English or French)
	Read	Write	Speak	Listen
High Proficiency (Maximum of sixteen (16) points)
Moderate Proficiency(Maximum of eight (8) points)
Basic Proficiency(Maximum of two (2) points)
No Proficiency(No points)
Second Canadian Official Language (either English or French)
	Read	Write	Speak	Listen
High Proficiency (Maximum of sixteen (16) points)
Moderate Proficiency(Maximum of eight (8) points)
Basic Proficiency(Maximum of two (2) points)
No Proficiency(No points)

Factor 3 – Work Experience - (maximum 21 points)

You must have at least one year of full-time paid work experience, or the equivalent in part-time work, in an occupation listed in the National Occupational Classification (NOC) list. Your experience must be listed in an occupation listed in Skill Type 0 or Skill Levels A or B of the NOC and it must have occurred in the past 10 years. You must have performed most of the duties, including all the essential duties, that are listed for the occupation.

PLEASE NOTE:
If your work experience is not listed in Skill Type 0 or Skill Levels A or B of the NOC, or if your experience did not occur in the past 10 years, your application will not be accepted.

To determine your points, first assess your work experience, and then complete the following:

Your Work Experience is
Less than 1 year
More than 1 year but less than 2 years
More than 2 years but less than 3 years
More than 3 years but less than 4 years
4 or more years

Factor 4 – Age - (maximum 10 points)

Points are given for your age at the time your application is received.

Please Enter Your Age in Years
less than 17	20	52
17	21-49	53
18	50	Over 53
19	51

Factor 5 – Arranged Employment - (maximum 10 points)

To obtain points for this factor, you must have a permanent job offer in Canada, be capable of carrying out the work, and likely to accept the job. The job offer must be in an occupation listed in Skill Type 0 or Skill Level A or B of the National Occupational Classification. One of the following situations must also apply.

1. You are working in Canada on a temporary work permit and
1. your temporary work permit was issued after receipt of a confirmation of your job offer from Human Resources and Skills Development Canada (HRSDC);
2. you are currently working in that job;
3. the work permit was valid at the time you made your permanent resident visa application and at the time the visa, if any, is issued; and
4. your employer made an offer to employ you on an indeterminate basis once the permanent resident visa is issued.

OR
2. You are working in Canada on a temporary work permit and
1. your temporary work permit was exempted from the requirement of a confirmed job offer from HRSDC on the basis of an international agreement (e.g., NAFTA or GATS), a significant benefit to Canada (e.g., intra-company transfer) or public policy on Canada’s academic or economic competitiveness (e.g., post-graduate work);
2. you are currently working in that job;
3. the work permit was valid at the time you made your permanent resident visa application and at the time the visa, if any, is issued; and
4. your employer made an offer to employ you on an indeterminate basis once the permanent resident visa is issued.

OR
3. You are working in Canada on a temporary work permit and
1. the circumstances described in 1 and 2 above do not apply to you;
2. your employer has made an offer to employ you on an indeterminate basis once the permanent resident visa is issued; and
3. your permanent job offer has been confirmed by HRSDC. You cannot apply to HRSDC yourself. Your employer must apply for you.

OR
4. You do not intend to work in Canada before being issued a permanent resident visa, you do not hold a temporary work permit, and
1. the employer has made an offer to employ you on an indeterminate basis once the permanent resident visa is issued; and
2. your permanent job offer has been confirmed by HRSDC. You cannot apply to HRSDC yourself. Your potential employer must apply for you.
3. you meet the Canadian licensing or regulatory requirements for the job.



No Arranged Employment
Arranged Employment

Factor 6 – Adaptability - (maximum 10 points)

You can receive a maximum of 10 points based on any combination of the elements listed below:

1. Accompanying Spouse / Common-Law Partner’s Education:
Secondary school diploma or less
A one-year diploma, trade certificate or apprenticeship and completed at least 12 years of full-time or full-time equivalent studies
A one-year diploma, trade certificate or apprenticeship or university degree at the bachelor’s level and completed at least 13 years of full-time or full-time equivalent studies
A two-year diploma, trade certificate or apprenticeship or university degree at the bachelor’s level and completed at least 14 years of full-time or full-time equivalent studies
A three-year diploma, trade certificate or apprenticeship (not university) and completed at least 15 years of full-time or full-time equivalent studies
Two or more university degrees at the bachelor’s level and completed at least 15 years of full-time or full-time equivalent studies
A master’s or Ph.D. and completed at least 17 years of full-time or full-time equivalent studies
Not Applicable

2. Principal Applicant or Spouse / Common-Law Partner has studied in Canada
No, or has less than two years post-secondary education in Canada
Completed at least two years of post-secondary education in Canada since the age of 17

3. Principal Applicant or Spouse / Common-Law Partner has worked in Canada
No, or has worked full-time in Canada for less than one year
Worked full-time in Canada for at least one year

4. Principal Applicant has obtained points under Factor 5, Arranged Employment
No arranged employment
If the applicant has earned points under arranged Employment in Canada (Factor 5) additional

5. Principal Applicant or Spouse / Common-Law Partner has family in Canada
No family in Canada
Family in Canada (parent, grandparent, aunt, uncle, sister, brother, niece, nephew, child or grandchild, spouse or common-law partner who is a Canadian citizen or permanent resident living in Canada)