Temporary Foreign Worker Program

FOREIGN LIVE- IN CAREGIVER APPLICATION

Privacy Notice

I understand the information contained on this form and on any sheet attached thereto, including information that qualifies as personal information within the meaning of the Privacy Act, as well as any other information and personal information collected by Human Resources and Skills Development Canada (HRSDC) for the purpose of providing a labour market opinion pursuant to the Immigration and Refuge. Protection Regulations shall be used by HRSDC and shared with Citizenship and Immigration Canada (CIC) solely for that purpose. I understand that this information may also be shared with federal, provincial, and/or territorial governments. This information may be shared with Provincial/Territorial government for the purpose of administration and enforcement of Provincial/Territorial legislation, including employment standards and occupational health and safety legislation. Finally, I understand that this information may also be used by HRSDC and shared with CIC for policy analysis, research and/or evaluation in relation to the entry and hiring of foreign workers to Canada or the Immigration and Refugee Protection Act.

I understand that I have no obligation to complete and sign this application, but that failure to do so may prevent HRSDC from providing a labour market opinion as required by the Immigration and Refuge Protection Regulations.

Authority to collect the information contained on this form and on any sheet attached thereto, including any information that qualifies as personal information within the meaning of the Privacy Act, as well any other information and personal information collected by HRSDC for the purposes described above is provided under the Department of Human Resources Development Act and the Immigration and Refugee Protection Act. Once under the control of HRSDC, the information contained in this form and on any sheet attached thereto that qualifies as personal information within the meaning of the Privacy Act, as well as any other personal information collected by HRSDC for these purposes is administered in accordance with the Privacy Act. The Privacy Act gives individuals the right to access their personal information under the control of a federal government institution. Instructions for making formal requests are outlined in the publication Info Source, copies of which are located at all Human Resources Centres of Canada or at the following Internet address:http://infosource.gc.ca. httn://infosource.oc.ca The personal Information collected by HRSDC for the purposes described above will be retained in Personal information Bank "HRDC PPU 440".

FILL OUT THIS APPLICATON ONLY IF: You are an employer (or an authorized third party) who has made an offer of employment to a foreign live-in caregiver. Please note the new regulatory requirement for a signed employment contract with the foreign live-in caregiver. (A sample contract can be found on the CIC site.

Information on this form should match information on the employment contract.

In completing this form, please keep in mind the definition of a live-in caregiver as stated in the Immigration and Refugee Protection Act and Regulations:

A "live-in caregiver" means a person who resides in and provides child care, senior home support care or care of the disabled without supervision in the private household in Canada where the person being cared for resides.

EMPLOYER INFORMATION

1. Employer ID # (if applicable):____________________________

2. Canada Revenue Agency Buisiness number:_______________

(15 digit code is mandatory)____________-RP_______

3. Given Name(s):_____________________ 

Family Name:______________________

4. Telephone (Home):_______________  5. Telephone (Work):_______________

6. Address: Number / Street / PO Box# :____________________________

7. City:______________   8. Province:______________

9. Postal Code:______________  10. E-Mail:______________

11. Fax:______________

12. Have you previously employed a foreign live-in caregiver?  Yes:____ No:____

13. Preferred Official Language of Correspondence :  English:____   French :____

ALTERNATE CONTACT PERSON

(Spouse, Common-Law-Partner, Other Relative, if applicable)

14. Given Name(s):_____________________  15. Family Name:______________________

16. Telephone: ______________________

* THIRD PARTY INFORMATION (if applicable)

17. Third Party ID # (if applicable)

18. Canda Revenue Agency Business Number

(15 digit code is mandatory)____________-RP_______

19. Company Name:______________________

20. Third Party Representative authorized to act for employer:______________________

 

21. Preferred Official Language of Correspondence :  English:____   French :____

22. Address: Number / Street / PO Box# :____________________________

23. City:______________   24. Province:______________25. Country________

26. Postal Code:______________  27. Telephone Number:_______________ Extension: __________

28. Fax Number:______________  29. E-Mail:__________________

*If you are a third party representative acting on behalf of an employer, written authorization from the employer to act on his/her behalf is required. Employers who wish to have third party representation should fill out the "Appointment of Representative" sheet attached to this form. HRSDC reserves the right to contact the employer directly if necessary.

DETAILS OF JOB OFFER

30. Expected duration of employment:

months:______  years:______

31. Relationship to Employer
Relationship of designated individual (person being cared for) to employer	The live-in caregiver must provide care for at least one designated individual. A designated individual is defined as: a child (18 or under), an elderly person (65 or older), or a person with a disability. Details of individuals to be cared for are as follows :
______________	Child Care:____	Care of elderly person:____	Care of person with disability:____
______________	Child Care:____	Care of elderly person:____	Care of person with disability:____
______________	Child Care:____	Care of elderly person:____	Care of person with disability:____

Note: To meet the regulatory requirement of the live-in caregiver program the live in caregiver's main duties must involve care of a designated individual.

32. Location where care will be provided and where live-in caregiver will reside: Address________________________ City_________ Province/Territory______________________ Postal Code: _____________

33. Main duties of job (including personal care for the designated individual, as well as other duties such as meal meal preparation, shopping, driving, housekeeping, etc.):_______________________________

• A live-in caregiver is required to have a high school education.
• A live-in caregiver is required to have the ability to both speak and write in at least one of the official languages.

34. A copy of the employer-employee contract (signed by the employer) must be included with this application form. Contract included? Yes___ No___

35. Language requirements:

Oral:
English____  French____  Other____

Written:
English____  French____  Other____

If “Other”, please explain.____________________________

36. Hourly wage:______

37. Total hours of work per week:______

38. Number of days off per week:______

39. Accommodation charges (does not apply in Quebec) ?
per- Week:______   per- Month:______

40. Meal charges (if not already included in the accomodation charges) ?
per- Week:______   per- Month:______   Not applicable_____

41. Private furnished accomodation with lock provided? Yes___ No___

42. Number of paid sick leave days per year: ____

43. Number of paid vacation per year: In days___    Or %age___

44. Other benefits:____________________________

45. Have you attempted to recruit Canadians/permanent residents for this job?

Yes:______   If yes, provide details of your recruitment efforts and the results.
________________________
(Attach supporting documentation such as advertisements in local newspapers, information on the qualifications of Canadian applicants and why they were rejected)

If you posted your job offer on Job Bank, please provide the Job Bank Order Number(s): _____________

No:______   If no, please explain.________________________

46. I/We (the employer(s)) agree to abide by the following requirements of the Live-In Caregiver Program (check boxes to indicate agreement):

• Provide medical coverage until the foreign caregiver is eligible for provincial/territorial health care (where applicable) ___
  
• Register the foreign caregiver under the appropriate provincial workers compensation / workplace safety insurance plan ___
  
• Cover all recruitment costs related to the hiring of the foreign caregiver ___
  
• Provide a suitable furnished private room with a lock that provides adequate and suitable living and sleeping facilities ___
  
• Pay full transportation costs for the foreign caregiver to travel to Canada and/or to the location of work (i.e. where care will be provided) ___
  
• Review and adjust the foreign caregiver's wages to ensure they meet or exceed the current prevailing wage (as per HRSDC web site) ___

FOREIGN LIVE-IN CAREGIVER INFORMATION

47. Name of Live-in Caregiver: Family Name:________________________

Given Name(s):________________________

48. Gender: Male:______   Female:______

49. Date of Birth (yyyy-mm-dd):_______________

50. Country of Residence (where worker currently lives):_______________

51. Citizenship:_______________

52. If the live-in caregiver is currently in Canada, please indicate the immigration status:

foreign worker (live-in caregiver):___

foreign worker (not live-in caregiver):___ 

refugee claimant:___  visitor:___ foreign student:___

DECLARATION OF EMPLOYER

 

I understand that following the confirmation of my Labour Market Opinion and the issuance of a work permit to a foreign national, Human Resources and Skills Development Canada (HRSDC) and/or Service Canada may contact me to verify that I have upheld the terms of employment as set out in the Labour Market Opinion confirmation letter and associated annex and that information collected by HRSDC and Service Canada may be shared with federal and provincial/territorial government bodies to enforce federal and provincial/territorial law where our authorities permit as stated in the Privacy Notice.

I have read and understand the Privacy Notice. I certify that the information provided in this application is true and accurate.

Name of Employer (Please Print):________________  

Signature of Employer:__________________

Date:________________

SIGNATURE OF THIRD PARTY (if applicable)

I certify that the information provided in this application is true and accurate to the best of my knowledge.

Signature of Third Party Representative:__________________

Name of Third Party Representative(Please Print):________________  Date:________________

INFORMATION FOR EMPLOYERS

Please forward this application to the Service Canada Center in Ontario, responsible for processing foreign live-in caregivers applications:

Service Canada
Temporary Foreign Worker Program
P.O. Box 6500
Toronto LCD, Downsview A
Toronto ON M3M 3K4

Fax: 416-954-3107 or 1-866-720-6094 (toll free)

Once an Officer assesses this application, the employer will be notified of the decision.

APPOINTMENT OF REPRESENTATIVE

To Human Resources and Skills Development Canada (HRSDC):

FOR THE PURPOSES OF AN APPLICATION FOR A LIVE-IN-CAREGIVER

I, ____________________(name of employer),

located at, ___________________(full address)

hereby appoint, ___________________(name of representative)

Telephone Number:__________  Fax Number:__________

of, ____________________(full address)

Telephone Number:__________  Fax Number:__________

as my representative to act on my behalf in relation to obtaining from Human Resources and Skills Development Canada a temporary employment confirmation of an offer of employment to, ____________________(name of individual to whom employment has been offered)

I hereby agree to ratify and confirm all that my representative shall do or cause to be done by virtue of this appointment.

This appointment shall remain in full force and effect until, __________(Date yyyy-mm-dd) unless due notice in writing of its revocation has been given to HRSDC.

___________________(signature of employer)   __________Date (yyyy-mm-dd)

___________________(print name of employer)

Personal Information is administered in accordance with the Privacy Act. It will be retained in Personal Information Bank HRDC PPU 440. Individuals have the right to access their personal information. For instructions, please consult the government publication Info Source found in Human Resource Centres of Canada and available at the web site: http://infosource.gc.ca

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