Notice Regarding Collection, Use, and Disclosure of Personal Information by the University

CIC Required information to complete Offer of Employmentto a foreign national exempt from Labour Market Impact Assessment (LMIA) and

Employer Compliance Fee

Please ensure the Visiting Student is informed of the following notice before submitting Information.

Notice Regarding Collection, Use, and Disclosure of Personal Information by the University

Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of processing the Citizenship and Immigration Canada’s IMM5802 Employer Compliance form and paying the employer compliance fee. Your personal information may be disclosed to Citizenship and Immigration Canada in order to obtain documents required for the work permitapplication process.Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.

Please provide a copy of the Letter of Invitation
Please provide a copy of the Award Letter
Payment of $230.00 employer compliance fee (department visa will be charged)
Please complete all sections of the form including Visa card information
Email all documents to Nancy Schneider:
Pleaseemail it back as word document

Important note: Please indicate and / or ask the visiting student whether they are coming to Canada through the International Experience Canada Program. The student should ask the Canadian Embassy about what type of LMIA exemption we should apply for. This is important since we will have to choose a particular category when we apply online. Thank you.

Will student coming to Canada through the International Experience Canada Program?

(check one)

YES ☐NO ☐

Foreign Worker info (As shown on passport. Include hyphens, spaces, accent and capitalization):

Family Name (surname):

Given name(s):

Gender: (check one)

Male ☐Female ☐Unspecified ☐

Date of Birth:

Year (YYYY) / Month / Day
Choose an item. / Choose an item. /

Country of Birth:

Country of Residence:

Citizenship:

Passport Number:

Explanation of how the job meets the requirements of the exemption being requested:(please explain in few sentences why we are inviting this person from outside Canada, what special skills, unique knowledge, training, research capacity or expertize the visitor has?

Job Title:

Visiting International Student Research Intern

Physical Job location:

Room Number:
Street Number:
Street Name:
City & Province:
Postal Code:

Will the worker perform job duties at more than one location? (check one)

YES ☐NO ☐

Expected start date of employment:

Year / Month / Day
Choose an item. / Choose an item. / Choose an item. /

Expected duration of employment:

Main duties of the job:

Minimum education requirements of the Job:

Choose an item.

Other training required (eg. First Aid):

Experience/skills requirements of the job:

Are there any provincial/territorial/federal certification, licensing or registration requirements of the job?

YES ☐NO ☐

Name and Contact Information of the Grantee/Professor/PI:

First & last name of Professor:
Title:
Phone Number:
Email Address:

Please include information on the academic award received. Provide name and amount of funder.

Form Completed by:

Name:
Phone Number:

☒ I ______solemnly declare that the information I have provided is true and accurate.

(name)

Departmental Visa Card information:

Name (as it appears on the visa card):
Visa Card Number(no spaces or hyphens):
Visa Card Expiry date:
3 digit security code (on the back of the card):

J:vp research/VISRI/CIC VISRI/CURENT CIC required information