Canadian_IMM_1444 PDF form, Free download.

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Form Name:   Canadian_IMM_1444
Tags:   canadian immigration, US canadian criminal rehabilitation
Posted Date:   2/9/2010
Size:   305KB
Type:   .PDF
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DETAILS OF ALL OFFENCES AND CONVICTIONS MUST BE ACCURATELY RECORDED ON THIS DOCUMENT. PROVIDING FALSE OR MISLEADING INFORMATIONWILL LIKELY RESULT IN A REFUSAL OF YOUR APPLICATION AND MAY PERMANENTLY BAR YOUR ADMISSION TO CANADA.WARNINGAPPLICATION FOR CRIMINAL REHABILITATIONIMM 1444 (03-2009) ECitizenship andImmigration CanadaCitoyenneté etImmigration CanadaPROTECTED WHEN COMPLETED - BPAGE 1 OF 4Language of correspondenceFrenchEnglishORDATE(S) OF OFFENCE(S)/CONVICTIONWidowedMy home address isNo. & streetCity/TownAPPLICATION FOR APPROVAL OF REHABILITATIONTimeNo.All correspondence should be mailed to box 8 or to:All other names that I use or have used (Include maiden name, previous married name(s), aliases and nicknames, legal change of name)SexFOR INFORMATION ONLYFamily name(s)Date of birthGiven name(s) - Do not use initialsSECTION BTO BE COMPLETED BY APPLICANTCountry of birthCitizenshipMarital statusSingleSeparatedMarriedDivorcedGiven name(s)2) Family nameGiven name(s)Province / State / CountryDAYMONTHYEARMONTHDAYPLACE OF OFFENCE(S)/ CONVICTIONSENTENCE(S)STATUTE NUMBER(S)On a separate sheet of paper, explain in detail the events/circumstances leading to the offence(s)/conviction(s). Indicate #15: Events / Circumstances onthe sheet of paper.Postal / ZIP codeApt./UnitSECTION ATO BE COMPLETED BY APPLICANTMaleFemale1) Family nameMailing addressNo. & streetCity/TownProvince / State / CountryPostal / ZIP codeApt./UnitIndicate most convenient timeto reach you by telephonePMAMHome telephone no.Area codeNo.Business telephone no.Area codeNo.Fax no.Area codeI may be inadmissible to Canada because of the following offence(s): (use a separate sheet if necessary, entitled #14: Offences / Convictions)10121234567891112131415OFFENCE(S)/CONVICTIONCommon-lawThis form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.(DISPONIBLE EN FRANÇAIS - IMM 1444 F)YEARIMM 1444 (03-2009) EDATEFROM Provide the details of your employment history since the age of 18. Start with the most recent information. Under "OCCUPATION", write your occupationor job title if you were working. If you were not working, provide information on what you were doing (for example: unemployed, studying, travelling, indetention, etc.). Note: Please ensure that you do not leave any gaps in time. Failure to account for all time periods will result in a delay in the processing of your application. I certify that the information provided by me is true and complete to the best of my knowledge. I also certify that I am not currently charged with any criminal offence.Explain the purpose of your visit or stay in CanadaOn a separate sheet of paper, provide reasons why you consider yourself to be rehabilitated and why you do not represent a risk to public safety. Indicate#17: Rehabilitation Factor on the sheet of paper.Addresses since the age of 18. (Use a separate sheet if necessary)Forms will be returned if there is any period of time for which you have not shown an address. Do not use post office (P.O.) box adresses.NAME AND ADDRESS OF COMPANY(Write name in full, do not use abbreviations)OCCUPATIONTHE INFORMATION YOU PROVIDE IN THIS DOCUMENT IS COLLECTED UNDER THE AUTHORITY OF THE CANADA IMMIGRATION AND REFUGEE PROTECTION ACT AND IS STORED INPERSONAL INFORMATION BANK NUMBER CIC PPU 042, 054 OR 300. THE INFORMATION IS PROTECTED UNDER THE PROVISIONS OF THE PRIVACY ACT AND IS ACCESSIBLE TO YOUUPON REQUEST.16PAGE 2 OF 417181920SIGNATURE OF APPLICANTTODATESMONTHMONTHYEARYEARDAYMONTHYEARDATESMONTHYEARMONTHYEARTOFROMNUMBER AND STREET(Do not use P.O. boxes)PROVINCE / STATECOUNTRYAPT.No.CITY OR TOWNIMM 1444 (03-2009) EYEARDAYMONTHDateReceipt no.GSTName of originating officeCost recovery codeFile no.NHQ file no. (if known)Fee•FOSS / NCMS ID no.Equivalent offence(s) under Canadian lawMaximum penalty under Canadian lawIf subject is not eligible, state reason(s)Officer's recommendationReasons for recommendationName of officerSignature of officerI recommend approval of rehabilitationI do not recommend approval of rehabilitationI recommend an application for a Temporary Resident's PermitI do not recommend an application for a Temporary Resident's PermitPAGE 3 OF 4SECTION CTO BE COMPLETED BY THE OFFICER.14625371112131415Inadmissibility provision(s)Eligible to apply for rehabilitation?NoYesDate when subject was / will be eligible8910A36(1)a)A36(2)a)A36(1)b)A36(2)b)A36(1)c)A36(2)c)YEARDAYMONTHIMM 1444 (03-2009) EAuthority from the Minister's delegate for relief under A36(2)(b) or A36(2)(c) grantedI certify that a copy of these documents has been provided to the applicant and that the applicant has been given an opportunity to provide comments.DateNotification by (fax/e-mail) received that authority fromthe Minister for relief under A36(1)(b) or A36(1)(c) was:Reviewing officer's recommendation1716SIGNATURECommentsI concur / approveI do not concur / approveName of reviewing officerSignature of reviewing officerSECTION DFOR OFFICE USE ONLYName (please print)TitlePAGE 4 OF 4181920Name of officerSignature of officer2223InitialsRefusedGrantedDateOther documentation (specify)NoYesList of documents or photocopies attached - check those attached21Documentation re: juvenile offenderDocumentation re: sentence, parole, probation, fine or pardonPolice certificatePassportText of non-Canadian statutesCourt judgement(s)Driver's License and USA Birth Certificate (USA-born citizens only)YEARDAYMONTHYEARDAYMONTHYEARDAYMONTHYEARDAYMONTHYEARDAYMONTHDateDateDate