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Employer-Driven Stream
Application for Nomination (AINP 003)
The personal information provided on this form and attachments is collected under the authority of section 33(c), and managed in accordance
with the Freedom of Information and Protection of Privacy Act. The information will be used for the purpose of administering the Alberta
Immigrant Nominee Program. If you have any questions about the collection of this information, you can contact the Alberta Immigrant
Nominee Program, Suite 940, ATB Place North Tower, 10025 Jasper Avenue, Edmonton, Alberta, Canada, T5J 1S6.
Email: ainp.info@gov.ab.ca. Fax: 780-427-6560.
A. Candidate Details File Number (office use):
Candidate's family name: Candidate's given name(s):
Candidate's Gender:
Male Female
Candidate's residential address:
City / Town: Prov. / Terr. / State: Postal / Zip code: Country:
Canada
City / Town:
Candidate's mailing address: (check here if same as above)
Postal / Zip code: Country:
Candidate's home phone: Candidate's cell phone: Candidate's work phone: Candidate's fax:
Candidate's email: Candidate's date of birth: (yyyy/mm/dd)
Candidate's place of birth: (city or town)
Candidate's country of birth: Candidate's country of citizenship:
Candidate's intended province or territory
of residence in Canada:
Prov. / Terr. / State:
Language of Communication:
English French
Native Language
B. Citizenship and Immigration Canada (CIC) Application History
Have you, your spouse/common-law partner, or any of your dependent children, already submitted an application for permanent
residence in Canada to Citizenship and Immigration Canada (CIC)? Yes No
If Yes, respond to each of the following:
Canadian visa office to which application for permanent
residence was already submitted:
Date application submitted: (yyyy/mm/dd)
Status of application: CIC File Number:
Principal applicant:
Intended province or territory of residence
on CIC application:
Application class/category:
Other Application class/category:
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C. Candidate's Occupation and Education
Current job title: Current wage or salary:
Hourly Annual $ CAD
Name of employer:
Candidates address of employment:
Country: Postal / Zip code: Prov. / Terr. / State: City / Town:
Education History
Do you have any formal education? Yes No
Years of formal education:
Level of education successfully completed: (check all that apply)
Doctorate / PhD
Master's Degree
Bachelor's Degree
Diploma (2 years)
Certificate (1 year)
Trade Certification/Apprenticeship
Secondary school
Other: (specify below)
Industry and Association Standards required and obtained:
Alberta Apprenticeship and Industry
Journeyperson Certification
College of Physicians and Surgeons of
College and Association of Registered
Association of Professional Engineers and Geoscientists of
Certification in Workplace Hazardous Materials Information System (WHMIS)
Other standards required and obtained (specify below):
Training (AIT)
Alberta
Nurses of Alberta (CARNA)
Alberta (APEGA)
Work History
Total years of employment:
List all employment since age 18 that is relevant to the job for which you are submitting this application: (add extra lines if necessary)
From (date): (yyyy/mm) To (date): (yyyy/mm)
Name of Employer:
Occupation:
City: Country:
From (date): (yyyy/mm) To (date): (yyyy/mm)
Name of Employer:
Occupation:
City: Country:
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From (date): (yyyy/mm) To (date): (yyyy/mm)
Name of Employer:
Occupation:
City: Country:
D. Family Members
Are you including a spouse or common-law partner who will accompany you to Canada? (do not include Canadian Citizens or
permanent residents) Yes No
Spouse or
common-law partner
Family name: Given name:
Date of birth:
(yyyy/mm/dd)
Gender:
Male
Female
Current job title: Number of years worked in Canada:
Education History
Do you have any formal education? Yes No
Years of formal education:
Level of education successfully completed: (check all that apply)
Doctorate / PhD
Master's Degree
Bachelor's Degree
Diploma (2 years)
Trade Certification/Apprenticeship
Certificate (1 year)
Secondary school
Other: (specify below)
Candidate's Spouse/Common-Law Partner's Occupation and Education
Are you including any dependent children who will accompany you to Canada? (Please refer to the CIC's website for the current
definition of dependent. Do not include Canadian Citizens or permanent residents) Yes No
Family name: Given name:
Date of birth:
(yyyy/mm/dd)
Gender:
Dependant
Male
Female
Dependant
Male
Female
Dependant
Male
Female
List each person living in Canada who is related to you or your spouse/common-law partner: (add extra lines if necessary)
E. Background in Canada and Alberta
Name of Relative:
Relationship:
City / Town: Years spent in Canada: Province / Territory:
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Name of Relative:
Relationship:
City / Town: Years spent in Canada: Province / Territory:
Name of Relative:
Relationship:
City / Town: Years spent in Canada: Province / Territory:
List any visits you have made to Canada, before you completed this form, where you had entered and then departed:
(add extra lines if necessary)
Reason for visit:
Province / Territory visited: Year/Month entered: (yyyy/mm) Year/Month departed: (yyyy/mm)
Reason for visit:
Province / Territory visited: Year/Month entered: (yyyy/mm) Year/Month departed: (yyyy/mm)
Reason for visit:
Province / Territory visited: Year/Month entered: (yyyy/mm) Year/Month departed: (yyyy/mm)
F. Document Checklist
I have attached all required and supporting document outlined in the document checklist: Yes No
The document checklist specific to this category can be found on our website:
Employer-Driven Skilled Worker Category and International Graduate: www.AlbertaCanada.com/skilled-dc.pdf
Employer-Driven Semi-Skilled Worker Category - www.AlbertaCanada.com/opportunity/immigrating/ainp-application-forms.aspx#2
G. Marketing
How did you learn about the AINP? (check all that apply)
Alberta promotional material
AINP website
Family member
Immigrate to Alberta Information Service
Recruitment agency
Alberta government webinar
Other: (specify below)
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H. Program Evaluation
AINP will be contacting you in the future for follow-up. Please provide the name of an additional contact person, preferably in Canada,
who we may contact if we cannot reach you. Do not list your authorized representative, your spouse/common-law partner or
your employer.
Family Name:
Given Name(s):
Phone number of contact person: Email of contact person:
I. Use of a Representative
I have used a representative or third party in connection with this application to the AINP. Yes No
If the answer is "yes", the Candidate must complete the Candidate - Use of a Representative (AINP 008B) form, (if this was not already
done), which can be found on our website: www.AlbertaCanada.com/AINP008B
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J. Declaration and Authorization of Candidate
By signing and submitting this form, I confirm that:

1. The information I have provided in this application is true, complete and correct and I, the candidate, have personally provided it.

2. I understand that:
a. the availability of AINP streams and categories is dependent on application volumes and labour market needs. AINP
streams and categories may be closed or suspended without prior notice. The AINP reserves the right to close application
intake for any AINP stream or category at any time, without prior notice. Further, the AINP may decline to consider
applications to closed or suspended streams or categories, regardless of when the applications were submitted. Changes
to the AINP, including notice of suspension or closure of its streams and categories are available on the AINP News Page
(www.albertacanada.com/opportunity/immigrating/ainp-news.aspx) and/or the AINP Application Forms page (www.
albertacanada.com/opportunity/immigrating/ainp-application-forms.aspx).
b. the AINP is not obligated to assess/process any applications submitted. Applications to the AINP are treated as an
expression of interest, and as such, will be processed according to quality of the application (completeness, eligibility),
labour market information, occupational supply and demand forecasting, AINP application volumes, and / or any other
factors at the AINPS discretion. By submitting an application to the AINP I acknowledge and agree that my application may
not be processed in the order received, or at all. Further, the decision to assess / process any particular application, and
the outcome of any such assessment / processing, is at the AINPS sole discretion. Program criteria are eligibility
minimums, and meeting program criteria does not guarantee that my application will be assessed, processed, or granted.

3. I understand that submitting an Application for Permanent Residence in Canada to Citizenship and Immigration Canada on the
basis of an Alberta Immigrant Nominee Program (AINP) Nomination issued by the Government of Alberta, is subject to federal
requirements. Specifically, my application for permanent residence is subject to the statutory requirements for admissibility under
the Immigration and Refugee Protection Act and its Regulations, and the Nomination and application do not guarantee that I will be
granted permanent residence in Canada.

4. I understand that the AINP may decline this application or withdraw a Nomination:
a. If I have submitted any false statements or concealed a relevant or significant fact. Both constitute misrepresentation;
b. If I do not comply with any request for information required by the AINP to effectively administer and maintain the integrity
of the program;
c. For reasons other than the above statements. As a result of this decline or withdrawal, the AINP may refuse to consider me
as a Candidate for Nomination for an unspecified period.

5. I understand all of the above statements, and have asked for and received an explanation, or language translation if required, on
every point about which I may have been uncertain.

6. I intend to reside and work in Alberta on a permanent basis.
K. Candidate's Authorization to Collect and Disclose Personal Information
By signing and submitting this form:

1. I acknowledge that the AINP will disclose, as necessary, information collected from this application under the program, to officials
in the Government of Alberta, including but not limited to partner ministries, and to officials administering immigration, temporary
foreign worker or other programs related to permanent residence or temporary residence within the Government of Canada.

2. I acknowledge that the Government of Canada will disclose, as necessary, personal information about me collected under the
Immigration and Refugee Protection Act and its Regulations to officials administering the AINP. I also acknowledge that the AINP
will collect such information.

3. I acknowledge that the AINP will disclose, as necessary, personal information collected from this and any other application
received by the AINP to third party evaluators used under contract by the AINP. I understand that the third party used by the AINP
will confirm my qualifications and background. The information provided to the third party evaluator will be shared with their
worksites in the required countries to perform this service on behalf of the AINP.

4. I acknowledge that the AINP and/or AINP's third party evaluator will contact previous institutions or employers I have identified to
verify my background and eligibility for the AINP, and I authorize the AINP to collect such information.

5. I authorize my current and past employers to provide details of my employment to the AINP and authorize the AINP to collect such
information.

6. I confirm my understanding of all the previous statements, and have asked for and received an explanation, or language translation
if required, of every point that was not clear to me.

7. I consent to be contacted to complete brief questionnaires to evaluate the program should I become a permanent resident as an
Alberta Provincial Nominee, as required by Citizenship and Immigration Canada. I understand that a third party may be used to
administer these questionnaires.
Candidate Authorization Original signatures are required on the application in blue ink.
Candidate's name (print) Signature (candidate)
Spouse's or common-law partner's name (print) Signature (spouse or common-law partner)
Dependent child's name, 18 years of age or older (print) Signature (dependant)
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Dependent child's name, 18 years of age or older (print) Signature (dependant)
Date signed (yyyy/mm/dd)