Guide 5290 - Live-in Caregivers (text version)

Text version: Request for Police Certificates/Clearances and Authorization for Release of Information

• Surname
• Given name(s)
• Other surname(s) used (example maiden name, previous married names)
• Name in original script (example Farsi, Arabic, Chinese, etc.)
• Date of birth (day, month, year)
• Place of birth
• Sex (male, female)
• Citizenship
• Current address in Canada (number, street, city, province and postal code)
• Dates
  • From (month, year)
  • To (month, year)
• Address(es) while resident in (name of country)

I authorize the police or relevant authorities in the country/state named above to disclose to Immigration Canada details about any previous criminal convictions that may exist.

• Signature of applicant
• Date (Day, Month, Year)

[End of text version - back to Request for Police Certificates/Clearances and Authorization for Release of Information]

Text version: Fingerprints Request Letter

• Surname
• Given name(s)
• Client ID no.
• Date of birth (day, month, year)

[End of text version - back to Fingerprints Request Letter]

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