Form IMM5710 "Application to Change Conditions, Extend My Stay or Remain in Canada as a Worker" - Canada

What Is Form IMM 5710?

Form IMM 5710, Application to Change Conditions, Extend My Stay, or Remain in Canada as a Worker, is a document that can be used by individuals who want to apply for a work permit with the same employer, restore their status as a worker, apply for a work permit for the first time (or with a new employer), or get a new temporary resident permit.

This form was issued by Immigration, Refugees and Citizenship Canada (IRCC) and was last revised on April 1, 2022. It is supposed to be submitted online on the official website of the Government of Canada, however, in some cases, it is allowed to submit it by paper. A fillable IMM 5710 PDF is available for download through the link below.

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How to Fill Out Form IMM 5710?

  1. Introduction. In the first part of the application, the individual can choose the language (English or French) they wish to correspond in and state the purpose of the application.
  2. Personal Details. Individuals can use this section of the document to designate their full name, gender, date of birth, place of birth, citizenship, current country of residence, and other personal information. They are also required to provide information about their spouse and information about their previous marriages (if applicable).
  3. Language(s). Here the individual can state their native language, specify if they are able to speak English or French, and which language from those two is the easiest for them to speak. The Individual can also state whether they have taken a test to assess their proficiency in English or French.
  4. Passport. This part of the form requires the individual to indicate their passport number, country of issue, date of issue, and its expiration date.
  5. National Identity Document. If the individual has a national identity document, they are supposed to state its number, country of issue, date of issue, and its expiration date in this part of the application.
  6. U.S. Permanent Resident (PR) Card. This section can be filled in if the applying individual is a lawful permanent resident of the U.S.
  7. Contact Information. The individual can use this part of the document to designate their current mailing address, residential address, telephone number, fax number, and email address.
  8. Coming Into Canada. This section requires the individual to fully describe their visit to Canada.
  9. Details of Intended Work In Canada. Here, the individual can depict their employment situation.
  10. Education. Individuals are supposed to use this part of the application to describe what kind of education they have, where they graduated from, and other details in connection with it.
  11. Employment. In this part, the individual is required to provide details about their employment for the past ten years.
  12. Background Information. If the individual is 18 years older, they are supposed to answer questions from this section. It includes questions about their health, military service, criminal offense, etc.
  13. Signature. At the end of the document, the individual is supposed to put their signature, full name, and date.

According to the IMM 5710 document checklist, there are a few things that should be attached to the completed application. They include photocopies of passport pages, proof of payment, photocopy of the individual's current immigration documents, and other documents. The exact list of attachments will depend on the situation of the applying individual.

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l♦I
Government
Gouvernement
PROTECTED WHEN COMPLETED- B
of Canada
du Canada
PAGE 1 OF 5
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
If you need more space for any section, print out an additional page containing the appropriate section, complete and submit it with your application.
I
L!.J UCI
� * I want service in
Validated
� I am applying for one or more of the following:
D •
D •
Apply for a work permit with the same employer
Apply for a work permit for the first time or with a new employer
D •
D •
Restore my status as a worker
Get a new temporary resident permit (for inadmissible applicants only)
PERSONAL DETAILS
� Full name
* Family name (as shown on your passport or travel document)
Given name(s) (as shown on your passport or travel document)
� a)
7
*No
*Yes
Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.)
b)
please provide the name (e.g. Nickname, maiden name, alias, etc.)
If you answered "yes" to question 2a),
Family name
Given name(s)
I
� Sex
� Date of birth
� Place of birth
*City/Town
* Country or Territory
*YYYY
*MM
*DD
� * Citizenship
I
Current country or territory of residence:
7
Country or Territory
Status
Other
From
To
*
*
Canada
L!J
YYYY-MM-DD
YYYY-MM-DD
a)
During the past five years have you lived in any country or territory other than your
Previous countries or territories of residence:
* Yes
*No
country of citizenship or your current country or territory of residence (indicated above) for more than six months?
b)
please provide details
If you answered "yes" to question Sa),
Country or Territory
Status
Other
From
To
YYYY-MM-DD
YYYY-MM-DD
I
L!J
YYYY-MM-DD
YYYY-MM-DD
* a) Your current marital status
Date
bl
(If you are married or in a common-law relationship)
Provide the date
on which you were married or entered into the common-law relationship
YYYY-MM-DD
c) Provide the name of your current Spouse/Common-law partner
Family name
Given name(s)
D
d) If you are married or in a common-law relationship, is your spouse or common-law partner a Canadian citizen or permanent resident?
No
Yes
FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE
Canada
This form is made available by Immigration, Refugees and Citizenship Canada and is not to be sold to applicants.
(DISPONIBLE EN FRAN�AIS - IMM 5 7 10 F)
o
IMM 571
(04-2022) E
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
l♦I
Government
Gouvernement
PROTECTED WHEN COMPLETED- B
of Canada
du Canada
PAGE 1 OF 5
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
If you need more space for any section, print out an additional page containing the appropriate section, complete and submit it with your application.
I
L!.J UCI
� * I want service in
Validated
� I am applying for one or more of the following:
D •
D •
Apply for a work permit with the same employer
Apply for a work permit for the first time or with a new employer
D •
D •
Restore my status as a worker
Get a new temporary resident permit (for inadmissible applicants only)
PERSONAL DETAILS
� Full name
* Family name (as shown on your passport or travel document)
Given name(s) (as shown on your passport or travel document)
� a)
7
*No
*Yes
Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.)
b)
please provide the name (e.g. Nickname, maiden name, alias, etc.)
If you answered "yes" to question 2a),
Family name
Given name(s)
I
� Sex
� Date of birth
� Place of birth
*City/Town
* Country or Territory
*YYYY
*MM
*DD
� * Citizenship
I
Current country or territory of residence:
7
Country or Territory
Status
Other
From
To
*
*
Canada
L!J
YYYY-MM-DD
YYYY-MM-DD
a)
During the past five years have you lived in any country or territory other than your
Previous countries or territories of residence:
* Yes
*No
country of citizenship or your current country or territory of residence (indicated above) for more than six months?
b)
please provide details
If you answered "yes" to question Sa),
Country or Territory
Status
Other
From
To
YYYY-MM-DD
YYYY-MM-DD
I
L!J
YYYY-MM-DD
YYYY-MM-DD
* a) Your current marital status
Date
bl
(If you are married or in a common-law relationship)
Provide the date
on which you were married or entered into the common-law relationship
YYYY-MM-DD
c) Provide the name of your current Spouse/Common-law partner
Family name
Given name(s)
D
d) If you are married or in a common-law relationship, is your spouse or common-law partner a Canadian citizen or permanent resident?
No
Yes
FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE
Canada
This form is made available by Immigration, Refugees and Citizenship Canada and is not to be sold to applicants.
(DISPONIBLE EN FRAN�AIS - IMM 5 7 10 F)
o
IMM 571
(04-2022) E
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
I
PAGE20F 5
Applicant Name
Date of Birth
PERSONAL DETAILS (CONTINUED)
D
� a)
Have you previously b1111n married or in a common-law relationship?
•No
*Yes
b) Provide the following details for your previous Spouse/Common-law partner:
Family name
Given name(s)
e) Date of Birth
c) Type of relationship
d)
From
To
YYYY-MM-DD
YYYY-MM-DD
yyyy
MM
DD
LANGUAGE(SJ
2J •
a) Native language/Mother Tongue
*b) Are you able to communicate in English and/or French?
c) In which language are you most at ease?
D
•No
d) Have you taken a test from a designated testing agency to assess your proficiency in English or French?
*Yes
PASSPORT
2J •
� • Country or territory of issue
� * Issue date
Passport number
�•Expiry date
YYYY-MM-DD
D
YYYY-MM-DD
� • For this trip, will you use a passport issued by the Ministry of Foreign Affairs in Taiwan that includes your personal identification number?
•No
* Yes
D
� • For this trip, will you use a National Israeli passport?
•No
* Yes
NATIONAL IDENTITY DOCUMENT
2J
D
Do you have a national identity document?
•No
*Yes
� Document number
� Country or Territory of issue
� Expiry date
� Issue date
YYYY-MM-DD
YYYY-MM-DD
US PR CARD
D
2J
Are you a lawful Permanent Resident of the United States with a valid alien registration card (green card)?
•No
*Yes
� Document number
� Expiry date
YYYY-MM-DD
CONTACT INFORMATION
If submitting your application by mall:
- All correspondence will go to this address unless you indicate your e-mail address below.
- Indicating an e-mail address will authorize all correspondence, including file and personal information, to be sent to the e-mail address you specify.
- If you wish to authorize the release of information from your application to a representative, indicate their e-mail and mailing address(es) in this section and on the IMM5476 form.
2J
Current mailing address
P.O.box
Apt/Unit
Street no.
• Street name
• City/Town
• Country or Territory
• Province
• Postal code
Canada
D
� Residential address
Same as mailing address?
•No
*Yes
Apt/Unit
Street no.
Street name
City/Town
Country or Territory
Province
Postal code
Canada
D
D
D
� Alternate Telephone no.
� Telephone no.
Canada/US
other
Canada/US
other
Type
No.
Ext.
No.
Ext.
Country Code
Type
Country Code
I
I
I
I
I
I
� Fax no.
� E-mail address
D
No.
Ext.
Country Code
Canada/US
D
other
I
I
I
IMMIGRATION, REFUGEES AND CITIZENSHIP CANADA
IMM 571 0 (04-2022) E
IMMIGRATION, RfFUGlfS ET CITOYENNETf CANADA
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
PAGE3O F 5
Applicant Name
Date of Birth
!
COMING INTO CANADA
*Date
*Place
� Date and place of your original entry to
Canada
YYYY-MM-DD
� * a) The original purpose for coming to Canada
b)Other
Date
Place
� Date and place of your most recent entry to
Canada (if not the same as original entry)
YYYY-MM-DD
Document Number
If applicable, provide the document number of the most recent Visitor Record, Study
Permit, Work Permit or Temporary Resident Permit issued to you.
DETAILS OF INTENDED WORK IN CANADA
2J
* a) What type of work permit are you applying for?
b)Other
I
2
Details of my prospective employer (attach original offer of employment)
a) Name of Employer (If you are employed by a foreign employer who has been awarded a contract to provide services to a Canadian entity, please identify the foreign employer here)
b) Complete Address of Employer (Canadian or Foreign):
� Intended location of employment in Canada?
Province
City/Town
Address
My occupation in Canada will be:
Job title
Brief description of duties
L.!J
From
To
Labour Market Impact Assessment (LMIA) No. or Offer of Employment (LMIA Exempt) No.
Duration of expected
employment
YYYY-MM-DD
YYYY-MM-DD
2_J
If you have been issued a Quebec Acceptance Certifcate (CAQJ, provide the:
Certificate Number
Expiry Date
...!J
D*No
D *Yes
Have you been issued a certificate under the Provincial Nominee program?
EDUCATION
Have you had any post secondary education (including university, college or apprenticeship training)?
*No
D *Yes
If you answered "yes", give full details of your highest level of post secondary education.
From
Field and level of study
School/Facility name
yyyy
MM
To
City/Town
Country or Territory
Province/State
yyyy
MM
EMPLOYMENT
G ive details of your employment for the past 10 years, including if you have held any government positions (such as civil servant, judge, police officer, mayor, member of parliament,
hospital administrator)
From
• Current Activity/Occupation
• Company/Employer/Facility name
... . .
*YVYV
To
*City/Town
• Country or Territory
Province/State
yyyy
MM
IMMIGRATION, REFUGEES AND CITIZENSHIP CANADA
IMM 5710 (04-2022) E
IMMIGRATION, R�FUGl�S ET CITOYENNET� CANADA
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
From
To
From
To
PAGE4OF 5
Applicant Name
Date of Birth
!
EMPLOYMENT (CONTINUED)
Previous Activity/Occupation
Company/Employer/Facility name
....
yyyy
City/Town
Country or Territory
Province/State
yyyy
MM
Previous Activity/Occupation
Company/Employer/Facility name
. . ..
yyyy
City/Town
Country or Territory
Province/State
yyyy
MM
BACKGROUND INFORMATION
You must complete this section if you are 18 years of age or older.
_!__l
a) Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?
Yes
No
bl Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?
No
Yes
c) If you answered ''yes" to question 1 a) or 1 b), please provide details and the name of the family member (if applicable).
� a) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?
No
Yes
bl Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory?
No
Yes
cl Have you previously applied to enter or remain in Canada?
No
Yes
d) If you answered "yes" to question 2a), 2b) or 2c), please provide details.
D
No
Yes
� a) Have you ever committed, been arrested for or been charged with or convicted of any criminal offence in any country or territory?
bl If you answered ''yes" to question 3a), please provide details.
IMMIGRATION, REFUGEES AND CITIZENSHIP CANADA
IMM 5710 (04-2022) E
IMMIGRATION, R�FUGl�S ET CITOYENNET� CANADA
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
I
PAGESOFS
Applicant Name
Date of Birth
BACKGROUND INFORMATION (CONTINUED)
D
� a) Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve
No
Yes
or volunteer units)?
b) If you answered
to question 4a), please provide dates of service and countries or territories where you served.
"yes"
D
� Are you, or have you ever been a member or associated with any political party, or other group or organization which has engaged in or advocated violence
No
Yes
as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?
D
� Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?
No
Yes
SIGNATURE
Immigration, Refugees and Citizenship Canada (IRCC), or an organization at IRCC' request, may want to contact you in the future to ask you about any services you received from IRCC prior to
the application process (such as participation in an information forum), during the application process (including the application process itself as well as orientation or accreditation services),
and services received after arriving in Canada (including settlement, integration and citizenship). IRCC will use this information, along with the information provided by other individuals, for
research, performance measurement or evaluation purposes. IRCC will not use this information to make any decisions about you personally.
D
D
No
Yes
Do you consent to be contacted by IRCC, or an organization at IRCC's request, in the future? (Y/N)
I consent to the release to Immigration, Refugees and Citizenship Canada (IRCC) and Canada Border Services Agency (CBSA) of all records and information for the purpose of processing my
request that any government authority, including police, judicial and state authorities in all countries in which I have lived may possess about
This information will be used to evaluate
me.
my suitability for admission to Canada or to remain in Canada pursuant to Canadian legislation.
I declare that I have answered all questions in this application fully and truthfully.
Si nature of A
licant or Parent/Le al Guardian's for a erson under 18 ears of a e.
Date: YYYY-MM-DD
IMPORTANT NOTE:
This application must be signed and dated before It is submitted by mail.
Do not forget to include photos, fees (if applicable) and any other documents required. Review the application guide for more information and verify that you have completed and
provided all of the required documents as per the document checklist.
DISCLOSURE
Information provided to IRCC is collected under the authority of the Immigration and Refugee Protection Act (IRPA) to determine admissibility to Canada. Information provided may be shared with other Canadian government
institutions such as, but not limited to, the Canada Border Services Agency ((BSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), the Department of Foreign Affairs, Trade and
Development (DFATD), Employment and Social Development Canada (ESDC), the Canada Revenue Agency (CRA), provincial and territorial governments and foreign governments in accordance with subsection 8(2) of the
Privacy Act. Information may be disclosed to or validated with foreign governments, law enforcement bodies and detaining authorities with respect to the administration and enforcement of immigration legislation where such
sharing of information may not put the individual and or his/her family at risk. Information may also be systematically validated by other Canadian government institutions for the purposes of validating status and identity to
administer their programs.
Where biometrics are provided as part of an application, the fingerprints collected will be stored and shared with the RCMP. The fingerprint record may also be disclosed to law enforcement agencies in Canada in accordance
with subsection 13.11 (1) of the Immigration and Refugee Protection Regulations. The information may be used to establish or verify the identity of a person in order to prevent, investigate or prosecute an offence under any law
of Canada or a province. This information may also be used to establish or verify the identity of an individual whose identity cannot reasonably be otherwise established or verified because of physical or mental condition.
Canada may also share immigration information related to biometric records with foreign governments with whom Canada has an agreement or arrangement.
Depending on the type of application made, the information you provided will be stored in one or more Personal Information Banks (PIB) pursuant to section 10(1) of Canada's Privacy Act. Individuals also have a right to
protection and access to their personal information stored in each corresponding PIB under the Access to Information Act. Further details on the PIBs pertaining to IRCC's line of business and services and the Government of
Canada's access to information and privacy programs are available at the
lnfosource website
and through the IRCC Call Centre. Info Source is also available at public libraries across Canada.
IMMIGRATION, REFUGEES AND CITIZENSHIP CANADA
IMM 571 0 (04-2022) E
IMMIGRATION, RfFUGlfS ET CITOYENNETf CANADA
APPLICATION TO CHANGE CONDITIONS,
EXTEND MY STAY OR REMAIN IN CANADA AS A WORKER
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