(DISPONIBLE EN FRANÇAIS - IMM 0130 F)
PROTECTED WHEN COMPLETED - B
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SCHEDULE 3 - Temporary Resident to Permanent Resident Pathway:
Streams A & B and International Graduates
IMM 0130 (03-2021) E
The principal applicant must complete this form
If there is not enough space to provide all the necessary information, attach to this form a separate sheet of paper with further details. Print your name at the top for each additional
sheet and indicate the form's title and the number of the question you are answering.
SECTION 1: PERSONAL INFORMATION:
Family Name: (As shown in your passport) Given Name(s): (As shown in your passport)
ID/Client Number (if applicable): Date of Birth (YYYY-MM-DD):
SECTION 2: PUBLIC POLICY STREAM SELECTION:
To which public policy stream are you applying? (Select one)
Workers in-Canada: Stream A (healthcare)
Workers in-Canada: Stream B (essential non-healthcare)
International Graduates
French-speaking Workers in-Canada: Stream A (healthcare)
French-speaking Workers in-Canada: Stream B (essential, non-healthcare)
French-speaking International Graduates
SECTION 3: LANGUAGE PROFICIENCY:
Do you meet the minimum language requirements in the Canadian Language Benchmark (CLB) or the Niveaux de competence linguistique canadiens (NCLC) for
listening, speaking, reading and writing based on the requirements of the stream to which you are applying?
Workers in-Canada: Stream A (healthcare) & Workers in-Canada: Stream B (essential non-healthcare) CLB/NCLC 4 (in either English or French)
International Graduates CLB/NCLC 5 (in either English or French)
French-speaking Workers in-Canada: Stream A (healthcare) & French-speaking Workers in-Canada: Stream B (essential, non-
healthcare)
NCLC 4 (must be in French)
French-speaking International Graduates NCLC 5 (must be in French)
Yes (provide language test) No (you should not apply)
SECTION 4: CANADIAN EDUCATIONAL CREDENTIAL (if applying to the International Graduates Stream):
Have you completed an eligible program of study after December 31st, 2016 at a Designated Learning Institution in Canada?
Yes No
SECTION 5: PAST CANADIAN WORK EXPERIENCE (Workers in-Canada streams (A & B) (French speaking and English):
a) Do you have at least 12 months of authorized, full-time (or part-time equivalent) work experience in one or more eligible health-related occupations listed in Annex A or an
essential eligible occupation listed in Annex B within the last 36 months?
Yes No
b) Starting with your current position, list all your positions within the three years preceding the date of your application. For each position, identify the dates of your employment,
hours per week, your employer, the four digit National Occupational Classification (NOC) code, and your position/title.
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
Hours per week Employer NOC Position/Title
