Quebec Certificate of Selection Application Form

The following is a rough translation of the French application forms for a Quebec Certificate of Selection. I've tried to make it look as much like the original as possible, within the restrictions of HTML.
Instructions The Form
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Declaration

Instructions Page One

We thank you for your interest in Quebec.

To allow us to evaluate most precisely your possible chances of success, we are enclosing the Request for certificate of selection of Quebec (DCS) and Declaration (D-1-A) forms for a candidate intending to work in Quebec. You will want to complete the form, sign it and send it to the address indicated below. The transmission of these forms does not mean that your request will be accepted.

It is very important that you read the instructions on the first page of the forms, and that you answer all the questions accurately and enclose all the documents requested in the appendix.

Your spouse and any children over 18 years old who plan to accompany you must also complete the DCS form. Your wife must indicate her surname of birth. If need be, please communicate with our service who will forward the number of additional specimens of form DCS.

We ask you to note that the Government of Quebec requires expenses for the study of the file of a candidate pertaining to your category of immigrant. The payment of these expenses does not imply the acceptance of your request and they are not refundable in the event of refusal. The exigible rights in your case are mentioned in appendix.

On receipt of all of the documents and your payment, an adviser from our immigration service contact you.

We stress to you that the content of our files is strictly confidential; we do not give any information by telephone on requests for immigration.

Sincerely yours

The Immigration Service


Instructions Page Two

REQUIRED CONTENTS OF YOUR FILE

READ CAREFULLY

It is essential that all the documents indicated in the following list (and any others) are included in your file. Your request cannot be discussed if one or more documents are missing. In order to facilitate the study of your file, the documents must be forwarded in the following order:

  1. The payment of the expenses of study of your file: a bank certified cheque or international cheque certified in Canadian dollars made payable to the Delegation of Quebec. The payment must imperatively accompany your request, if not it will returned to you.
  2. One (1) request for Certificate of selection per adult. This is the principal applicant, the spouse, any children aged 18 years or older, and anyone else accompanying you. One (1) passport photograph for each person (adult and children) fastened to box 21 of the DCS of the principal applicant.
  3. The declaration of a candidate intending for the labour market (D-1-A).
  4. For you and your spouse, one (1) copy certified with the original and, if necessary, an official translation in French of:
  5. A statement of banking operations indicating the operations and the balance of your accounts for the last month, and a copy of your up to date savings account.
  6. A curriculum vitae (C.V.) up to date in French.
  7. A fastened photocopy of six the first (6) pages of your passport and that of each person who will accompany you.
  8. A certified photocopy of the certificate of marriage and certificates of birth of each child or certified photocopy of the notebook of family. If necessary, a certified photocopy of the certificate of divorce or death of the husband/wife.
  9. For the non-married people: if necessary, a certified photocopy of your certificate of cohabitation or another official documentary evidence attesting your common life.
  10. FOR PEOPLE LIVING IN FRANCE WHO DO NOT HAVE FRENCH NATIONALITY: A certified photocopy of your residence permit proving your residence in France.
Please make sure that all your documents are included in the order indicated before forwarding to us.

Instructions Page Three

Table of Exigible Rights

The cost for the examination of a request for a certificate of selection or commitment are calculated by taking into account the category of immigration and the number of people accompanying the principal applicant. The category associated with your request is notched in the rectangle provided for this purpose:
X
  WORKER CAD $
  Principal Applicant 300
  Spouse 100
  Each dependant child 100
X
  CONTRACTOR OR AUTONOMOUS WORKER CAD $
  Principal Applicant 700
  Spouse 100
  Each dependant child 100
X
  FAMILY SPONSORSHIP CAD $
  Husband, wife or fiancé 250
  Each dependant child 100
X
  Investor CAD $
  Principal Applicant 850
  Spouse 100
  Each dependant child 100

PAYMENT OF EXIGIBLE RIGHTS

The exigible payment of duty must be carried out in Canadian dollars by certified bank draft or certified international cheque, fastened to the Request of certificate of selection and made payable to the Délégation générale du Quebec.

N.B.: We must emphasise that a file must be accompanied by the payment. Any file not accompanied by the payment, or containing a personal cheque or a payment in different currencies than Canadian will be returned to you.

It is also significant to mention at the time of the deposit of your request, the name of the people with load who will not accompany you and their dates of birth.

* The rights of the spouse are the same as those of the principal applicant.


Instructions Page Four

NOTE

Before completing the enclosed form, we invite you to read the following information very carefully:

The candidates are evaluated according to the experience and training level of work. Therefore the selected candidates will generally have a profile meeting the following characteristics:

* VERY IMPORTANT *

If after having reading all of the provided information, you evaluate that you can meet our criteria, you can complete the application according to prescribed instructions' and forward it to us accompanied by the payment of the expenses required for the study of your file. The fact of presenting your dossier and of paying the expenses required does not guarantee the acceptance of your request. Your payment must accompany your file.


Instructions Page Six

Declaration of a candidate intending to work in Quebec

I, the undersigned __________________________________________, declare that:

I understand that I am likely to have difficulties obtaining employment in Quebec corresponding to my education or my experience and that taking account of foreseeable delays until my arrival in Quebec, the market situation of work could have changed and may have deteriorated.

I wish nevertheless to continue my project of establishment in Quebec.

I understand that it is my responsibility to assume the financial expenses connected to my establishment and, if necessary, with that of my family in Quebec. As indicated in box 17 of my application for certificate of selection, I declare that I will arrive at Quebec with the sum of _________, if I am accepted as a permanent resident.

I authorize the ministry of citizens and Immigration of Quebec to share, if necessary, information relating to the amount of money declared in this document to the Canadian immigration authorities and public organizations, specifically the ministry for the Security of income of Quebec.

Signed by _____________________________ on __________________________________
_________________________________ _________________________________
Candidate Partner
NOTE: Please return this declaration with your file.

INSTRUCTIONS TO FILL THE FORM

Carefully read the instructions before filling the form

HOW TO FILL IN THE FORM

  1. Please fill the form with the typewriter or in PRINTED LETTERS, with black ink. If a question does not apply to you, enter S/O (without object).
  2. If you lack space, please supplement your answer on a separate sheet, identified by the number that appears to the left of each section of the form.
  3. With sections 1 and 4, a married woman registers her surname of birth.
  4. With section 20, do not forget to sign your request.
  5. With section 21, the principal applicant must attach his/her photograph, and that of their partner and those of his/her dependent children. When the spouse or a dependent child fills the form, they attach only their own photograph on it.

WHO IS REQUIRED TO FILL IN THE FORM?

DEFINITION OF DEPENDENT CHILDREN

  1. The child who is less than 19 years old and who is not married (single person, widower or divorced).
  2. The child who is 19 year old or more, who is not married (single person, widower or divorce), who has been studying* full-time since the date of their 19th birthday and who is entirely or mainly financed by their parent.
  3. The child who is married and younger than 19, who has been studying* full-time since the date of their marriage and who is entirely or mainly financed by their parent.
  4. The child who is 19 years old or more, who suffers from a physical or mental incapacity which makes them unable to provide for their own needs who is entirely or mainly financed by their parent.

* This student must be registered in an educational establishment and to follow there, full-time and without interruption, other than for an interruption of not more the one year, courses of general, vocational or technical training.


(1) IDENTIFICATION
Surname at birth First Name
______________________________________________ ________________________________
Other name that you have uses or under which you have
été connu(e), including married name Sex
______________________________________________ O Male O Female
Date of Birth Birthplace
Year Month Day Town Province/State Country
____ __ __ ________________________________________________________
Citizenship Nationality (if it is necessary) passport or ID card number
_____________________________________ _____________________________________

(2) CURRENT FAMILY CIRCUMSTANCES (If your situation changes, warn us immediately)
O Single O Married O Divorced O Marriage Annulled O Fiancé O Separated O Widowed
Date and place of the marriage
Year Month Day City Country
____ __ __ ______________________________________
Have you been married more than once? Yes No

(3) PERMANENT ADDRESS
Number Street City Province / State Post Code Country
______ _________________________ _______________ _____________ _________ _____________
Postal address, if different
_______________________________________________________________________________
Telephone No
Home Work Other (specify)
__________________________ __________________________ __________________________
Fax No
Home Work Other (specify)
__________________________ __________________________ __________________________

(4) DEPENDANTS ACCOMPANYING YOU (your spouse, your dependent children, and dependent children resulting from this child). For the definition of a dependent children, see the instructions on the detachable page.
Family name at birth First Name Degree of relationship DOB Town of Birth Nationality
  Year Month Day
______________ ______________ ______________ ____-__-__ ______________ ______________
______________ ______________ ______________ ____-__-__ ______________ ______________
______________ ______________ ______________ ____-__-__ ______________ ______________
______________ ______________ ______________ ____-__-__ ______________ ______________
______________ ______________ ______________ ____-__-__ ______________ ______________

(5) ADDRESS OF YOUR SPOUSE AND YOUR DEPENDENT CHILDREN (if different from your permanent address
Number Street Town Country Telephone Fax
_____ _________________ _________________ _________________ _________________ _________________

(6) SYNOPSIS OF STUDIES
No of Years Language No of Years Language No of Years Language
Secondary Post-secondary University
____ ________ ____ ________ ____ ________

(7) PRIMARY, SECONDARY AND POST-SECONDARY EDUCATION (EXCEPT UNIVERSITY)
  Primary Seconday Post-Secondary
Duration From To From To From To
  ______ ______ ______ ______ ______ ______
Establishment _____________ _____________ _____________
Specialisation _____________ _____________ _____________
Certificates obtained _____________ _____________ _____________

(8) UNIVERSITY EDUCATION
  1 2 3
Duration
Establishment
Specialisation
Certificate obtained
OTHER EDUCATION WITH DIPLOMAS OR CERTIFICATES (SPECIFY)
 

(9) PROFESSIONAL EXPERIENCE: employment in the last ten years:
Duration Name and address of employer Occupation
From To
Year Month Year Month
____-__ ____-__ _________________________________ _________________
____-__ ____-__ _________________________________ _________________
____-__ ____-__ _________________________________ _________________
____-__ ____-__ _________________________________ _________________
____-__ ____-__ _________________________________ _________________
____-__ ____-__ _________________________________ _________________
____-__ ____-__ _________________________________ _________________

(10) Languages
French English
Excellent Good Poor None Excellent Good Poor None
Understanding           
Speech           
Reading           
Writing           

What is your main language? ________________

Do you speak any other languages? If yes, which? _______________

(11) WERE YOU ALREADY MEMBER OF AN ASSOCIATION SUPPORTING THE CULTURAL OR ECONOMIC RELATIONS BETWEEN QUEBEC AND YOUR COUNTRY? IF SO, SPECIFY:

Duration Name/Address of Association Type of Association Post Occupied
________ ____________________________________ ___________________ _______________

(12) HAVE YOU ALREADY PRESENTED:

A request for temporary stay in Canada? O No O Yes
Province: ___________ Date: ___________
O Accepted O Refused O Waiting for decision

A request for immigration to Canada or another country? O No O Yes
Country: ____________ Date: ____________
O Accepted O Refused O Waiting for decision

(13)
A) ARE YOU CURRENTLY RESIDENT IN QUEBEC?
O No  O Yes
If so, when? __________________

B) PLEASE SPECIFY THE REASONS FOR YOUR STAY OR FORMER VISITS TO QUEBEC:

DATES
___________________________________________ Tourism O No O Yes
___________________________________________ Work O No O Yes
___________________________________________ Study O No O Yes
___________________________________________ Refugee Status O No O Yes
___________________________________________ Business Trip O No O Yes
___________________________________________ Other (Specify) O No O Yes

(15) Do you have an offer of employment in Quebec?
O No O Yes
If Yes, O Written O Verbal
Name of Employer Address Telephone Employment offered
________________ ___________________________ ___________ __________________

(16) Do you have relations or friends in Quebec?
O No O Yes
If yes, specify:
Name Address Relation to you
______________________ ____________________________________________ _______________
______________________ ____________________________________________ _______________
______________________ ____________________________________________ _______________
______________________ ____________________________________________ _______________

(17) HOW MUCH MONEY DO YOU HAVE TO ESTABLISH YOURSELF IN QUEBEC AS A PERMANENT RESIDENT?

AMOUNT IN CANADIAN DOLLARS: ______________________

(18) LIST THE ADDRESSES YOU HAVE LIVED AT IN THE PAST TEN YEARS:
Duration Street Town Province/State Country
From To
Year Month Year Month
____ __ ____ __ __________________________ ___________________ ______________ ______________
____ __ ____ __ __________________________ ___________________ ______________ ______________
____ __ ____ __ __________________________ ___________________ ______________ ______________
____ __ ____ __ __________________________ ___________________ ______________ ______________
____ __ ____ __ __________________________ ___________________ ______________ ______________
____ __ ____ __ __________________________ ___________________ ______________ ______________

(19) IN WHICH TOWN OR REGION OF QUEBEC DO YOU DESIRE TO LIVE?

____________________________________________________________

(20)INFORMATION

The information required by this form is necessary for the study of your request for certificate of selection. Any omission or refusal to answer can result in a rejection of the request. The access to the information which you provide is reserved only for people authorized under the terms of the provisions of the Law on the access to the documents of public organizations and the protection of personal information (L.R.Q., C A-2.1). You can be informed of the information concerning you held by the minister responsible for the application of the Law on immigration to Quebec and, if it is necessary, to ask for correction in writing of it. For further information, write to the office that handles your request.

The minister can communicate personal information recuelli by the present request to the Canadian authorities of immigration and Quebec public organizations if this communication is necessary or application of a law to Quebec.

DECLARATION OF THE APPLICANT

I understand that the minister responsible for the application of the Law on immigration to Quebec can cancel or declare null and void a certificate of selection delivered on the faith of information or false or misleading documents, by error or when the requirements for the delivery of the certificate of selection ceased existing.

I declare that information provided in this request is exact and complete and I understand that the minister can check the accuracy of this information and that I break the law if I communicate information to the minister, investigator or the inspector which I know to be false or misleading with a request for certificate of selection.

In witness whereof, I signed at

TownDate

Signature:

(21) Attach a passport format photo of yourself and people who will accompany you (your spouse, your dependent children and that of your spouse and dependent children resulting from this child).