Fillable Printable Employer Declaration - Canada

Employer Declaration - Canada

Citoyenneté et

Immigration Canada

Citizenship and

Immigration Canada

PAGE 1 OF 1

IMM 5658 (04-2011) E

PROTECTED WHEN COMPLETED - B

EMPLOYER DECLARATION

This form should be completed and signed by the prospective *employer or employer representative (not agent or recruiter), and is intended for applications and requests for a work

permit (where the employer is specified) for a foreign national, submitted to a mission overseas, at a port of entry or to the Case Processing Centre in Vegreville, Alberta, where the

occupation does not require a Labour Market Opinion. This form is for the purpose of providing Citizenship and Immigration Canada or the Canada Border Services Agency with

employer information, which will assist in work permit processing under the Temporary Foreign Worker Program.

*For the purposes of this form, an employer or representative is the person authorized to sign contracts/job offers and responsible for ensuring wages, working conditions and/or

occupations are consistent with the terms of the contract/job offer. A representative acting on behalf of an employer must attach written authorization from the employer to act on his/

her behalf; however the employer is still bound by its obligations to honour the terms of the contract/job offer.

TEMPORARY FOREIGN WORKER

Family nameGiven name(s)

Date of birth (YYYY-MM-DD)

File number/Client ID (if available)

PART 1 - EMPLOYER IDENTIFICATION AND DETAILS

Name of employer/representative*Name of business

Name business operates under (if different)Canada Revenue Agency (CRA) business number

Branch/subsidiary

Business telephone number

Website (if applicable)Contact name

Job title of contact person

Phone number of contact person

Email address of contact person**

Fax number of contact person

Preferred official language

of correspondence

FrenchEnglish

Describe the principal business activity

**NOTE: By indicating your e-mail address, you authorize Citizenship and Immigration Canada to transmit your personal information to that specific e-mail address.

E-communication is our primary method of correspondence.

PART 2 – STATEMENT OF PRIVACY

I understand that employer information provided in support of a work permit application or request pursuant to the Immigration and Refugee Protection Act(IRPA) and Regulations

(IRPR), including information that qualifies as personal information within the meaning of the Privacy Act, as well as any other information collected by Citizenship and Immigration

Canada (CIC), the Canada Border Services Agency (CBSA) or Human Resources and Skills Development and Service Canada (HRSDC/SC), will be stored in Personal Information

Bank CIC PPU 054, Temporary Foreign Worker Records and Case File. It is protected and accessible under the Privacy Act and the Access to Information Act.

I understand that the information collected can be shared and used by CIC, CBSA and HRSDC/SC, under the Temporary Foreign Worker Program, for the purposes of administering

and enforcing the IRPAand its regulations; and that this information may also be shared with provincial and/or territorial governments for the purposes of the administration and

enforcement of provincial or territorial laws that regulate employment, or the recruiting of employees, in accordance with applicable legislation.

In accordance with the Privacy Actand the Access to Information Actindividuals have the right to protection of an access to their personal information. Details on these matters are

available at the Infosource website.

PART 3 – SIGNATURE AND DATE

I understand that non-compliance on the part of the employer of a foreign national in Canada, in relation to rendering wages, working conditions and/or occupation as stated in the

contract or job offer may result in the employer's ineligibility to participate in the Temporary Foreign Worker Program for a period of two years.

I have read and understand my obligations as the primary employer for this job offer, and the information provided on this form is true and accurate to the best of my knowledge.

Signature of Employer/

Representative*

Date (YYYY-MM-DD)

Printed name of employer/

representative

Title