Schedule 1: Rural and Northern Immigration Pilot (IMM 5911)

1. Enter your full family name (surname or last name) as shown on your passport, travel or identity document.
2. Enter all of your given name(s) (first, second or more) as shown on your passport, travel or identity document. Do not use initials.
3. Provide your passport or travel document number exactly as shown on the document. Make sure there is no space between each number or letter.
4. Enter your date of birth. If you do not know your complete date of birth, please use an “*” (asterisk) to fill in the spaces for the unknown year, month or day. For example, if the day and month of your date of birth is unknown you could enter 1964/*/*.
5. Enter your country of birth as shown in your passport or your travel document.
6. Enter your country of citizenship as shown in your passport.
7. The name of your current country of residence. Your country of residence is the country in which you are residing, provided that you have been lawfully admitted to that country.
8. Enter your telephone number including the country code, area/regional codes, etc. (et cetera). If you have an extension number, indicate it after your phone number under “Ext. (extension)”
9. If you have an email address, enter it here. (e.g.:name@provider.net)

   Note: By indicating your e-mail address, you are hereby authorizing the Economic Development Organization (EDO) and IRCC to transmit your file and personal information to this specific e-mail.

10. From the list, choose and enter your current marital status:
    • Annulled marriage
    • Common Law
    • Divorced
    • Married
    • Separated
    • Single
    • Widowed
    • Unknown
11. Enter the total number of family members who are coming to Canada with you (including yourself).
12. Enter your current residential address (where you live) by typing the following information:
    • Post Office Box (P.O. Box) number, if applicable. If you do not enter a post office box, you must provide the Street number
    • Apartment (Apt.) or Unit, if applicable
    • Street number (No.), if applicable. It is the number on your house or apartment building. You must provide a street number if you did not enter in a P.O. Box
    • Street name, if applicable
    • City or Town
    • From the list, select the Country of your current mailing address
    • Province or State
    • Postal code/zip code
    • District, if applicable

1. Enter the name of the business that has offered you employment.
2. Enter the business telephone number including the country code, area/regional codes, etc. (et cetera) If there is an extension number, indicate it after your phone number under “Ext. (extension)”
3. Enter the mailing address of the business that has offered you employment.
4. Enter the address of the place where you will be physically working (if different from business mailing address).
5. Enter the job title of the position being offered.
6. Enter the National Occupation Classification (NOC) code of the position being offered.
7. Enter the North American Industry Classification System (NAICS) code for the industry in which you will work (as identified in the job offer provided by your employer in the IMM 5984 form).
8. Provide a detailed list of the main duties (most significant duties) you are expected to perform in the position being offered.
9. Does the job have an end date? Respond “yes” or “no”.
10. Enter the expected start date of the job. If you are already working for the employer who offered you the job, enter, “Current employer”
11. Provide a brief explanation about how you found this job (Job Bank, newspaper, job fairs, etc.).
12. Respond “yes” or “no” if you met with your prospective employer prior to the job offer and how you met with them (Was it a face-to-face interview or remotely, (e.g. over telephone or Skype, etc.?)).

1. Enter the name of the approved language testing agency. See valid language test results for more information.
2. Enter the date when you received your language test results. You can find this information on your language test results page. This could also be the date the testing official signed them.
3. Enter the date when you took the test. You can find this information on your language test results page.
4. Enter your scores in the appropriate fields.

1. Respond “yes” or “no” as to whether you are an international student who graduated with an eligible credential from a Canadian public post-secondary institution in the community and exempt from the work experience requirement. If no, the following information must be completed.
2. Enter a start and end date of your employment. If no end date, enter “Ongoing”.
3. Enter the business name of your employer.
4. Enter the address of the work location.
5. Enter the job title of the position.
6. Enter the National Occupation Classification (NOC) code of the position you worked.
7. Provide a detailed list of the main duties (most significant duties)
8. Enter the name of your immediate supervisor or personnel officer at the business.
9. Enter the email address of your employment reference.
10. Enter the telephone number of your employment reference.

1. From the list, select your highest level of education. See Educational requirements for more information.
2. Enter the date you successfully completed your studies (graduation date).
3. Enter the name of the educational institution where you completed your studies and address.

4. If you have foreign credential, enter the information found on your Educational Credential Assessment (ECA). See How to get an educational credential assessment (ECA) for a list of IRCC designated organizations.

   1. Enter the name of the organization that issued your ECA.
   2. Enter the date your ECA was issued (year, month, day)
   3. Enter your ECA certificate number

1. Respond “yes” or “no” as to whether you have familiarized yourself with the “Proof of funds” requirement (if you are not currently working in Canada) and attest that you have sufficient funds to meet the requirements.

DECLARATION

• Signature of declarant
• Date (year, month, day)

Note: Once you have filled out the form, click on the “Validate” button located at the top of the form. Missing information will be identified by a pop up when you press the “validate” button. You should fill out your forms on a computer and validate them electronically to reduce mistakes and help you submit forms that are complete. Note: The form will not produce a barcode when it is validated.

For more information about the “validate” button, visit the Frequently Asked Questions/Help Centre.