Employment and

Social Development Canada

Please Print

Emploi et
Dveloppement social Canada

PROTECTED WHEN COMPLETED - B

LABOUR MARKET IMPACT ASSESSMENT APPLICATION

LOWER-SKILLED OCCUPATIONS
Employers should visit the Temporary Foreign Worker Program website at
www.esdc.gc.ca/eng/jobs/foreign_workers/index.shtml, to verify that the Program is accepting applications for the specific
occupation or sector for which they wish to hire the temporary foreign worker (TFW) and to determine if they are eligible to
participate in the Program.
Personal Information Collection Statement
The information you provide on this form is collected by Employment and Social Development Canada (ESDC) under the authority of the Immigration and
Refugee Protection Act (IRPA) and Immigration and Refugee Protection Regulations (IRPR), for the purpose of providing a Labour Market Impact Assessment
(LMIA) in accordance with these statutes. Completion is voluntary; however, failure to complete this form will result in your LMIA application not being
processed.
The information you provide may be shared with Citizenship and Immigration Canada (CIC) for the administration and enforcement of the IRPA and IRPR as
permitted by the Department of Employment and Social Development Act (DESD Act), and may be accessed by the Canada Border Services Agency (CBSA)
for the purpose of issuing work permits at Ports of Entry. ESDC may also provide information to CBSA in order for that agency to investigate and enforce the
IRPA and IRPR in relation to an LMIA.
The information may also be shared with provincial/territorial governments for the purpose of administration and enforcement of provincial/territorial legislation,
including employment standards and occupational health and safety legislation, as permitted by the DESD Act. The information may also be used by ESDC
for inspections, policy analysis, research and evaluation in relation to the entry and hiring of temporary foreign workers to Canada or the IRPA.
The information you provide is administered under Part 4 of the DESD Act and the Privacy Act. You have the right to access and request correction of your
personal information, which is described in Personal Information Bank PPU 440 and PPU 171 of Info Source. Instructions for making formal requests are
outlined in the Info Source publication available online at infosource.gc.ca.

A person, who contravenes a provision set out under sections 126 or 127 of the Immigration and Refugee Protection Act
(misrepresentation), could be liable to a fine or to imprisonment, or to both. Also, providing inaccurate information, in the context
of this application, may lead to an administrative penalty such as being ineligible to access the Program for a period of two years.

BUSINESS INFORMATION
1. Employer ID # (if applicable):

2. Canada Revenue Agency Business Number (first 9

digits are mandatory for Canadian businesses):

3. Business Legal Name:

4. Business Operating Name:

5. Business Mailing Address:

6. City:

7. Province/State:

8. Country:

9. Postal/Zip Code:

11. Business Address (if different than mailing address):

12. City:

13. Province/State:

10. Business Telephone Number:

14. Country:

16. Type of business (select all that apply):

incorporated/limited
partnership

sole proprietor

15. Postal/Zip Code:

Other, specify:

17. Is the business a franchise?

No
Yes If yes, provide the name of the corporation:
18. If the business is a franchise, is the corporate head office aware of this application for temporary foreign workers (TFW)?
Yes

No

Not applicable

19. Website Address:

20. Date Business Started

(YYYY-MM-DD):

21. Describe the principal business activity:

ESDC EMP5512 (2014-09-012) E

Page 1 of 11

22. Primary Contact Name:

First

Middle

Last

23. Job Title:

24. Contact Telephone Number

25. Fax Number:

Ext:

26. E-mail:

27. Preferred Official Language of Correspondence:

English

French

THIRD-PARTY, RECRUITER OR EMPLOYMENT AGENCY INFORMATION

1. Are you using the services of a third-party, recruiter or employment
agency for the purpose of hiring a temporary foreign worker?
No

2. Name of third-party, recruiter or employment agency:

Yes If yes, complete the boxes at the right

Note:
In some provinces/territories it is mandatory to be registered in order to
recruit temporary foreign workers on behalf of an employer. For more
information visit:
www.esdc.gc.ca/eng/jobs/foreign_workers/lower_skilled/index.shtml
4. Are you appointing a third-party to represent you in completing this LMIA
application form or to provide advice in an immigration process?

3. Registration, license or certificate number:

5. Name of third-party representative:

No
Yes If yes, complete Schedule A Third-party representative
6. A number of provinces/territories prohibit the charging of recruitment fees to temporary foreign workers for the purpose of securing a job offer. Have you the
employer or any other third-party in connection to this job offer received payment from the temporary foreign worker(s) to secure this offer of employment?
Yes

No

BUSINESS DETAILS
1. Number of employees currently employed nationally under this Canada Revenue Agency Business number (e.g. 5 franchises are covered by the business
number and there are a total of 100 employees):

2. Total number of employees currently employed at the work location specified on this form:

3. Total number of Canadian/permanent resident employees at the work location specified on this form:

4. Total number of employees (including Canadians/permanent residents and TFW) working in this occupation at this work location:

5. What is the wage range for these employees (including Canadians/permanent residents and TFWs) working in this occupation at this work location?
Lowest-wage: $

/hour

Highest-wage: $

/hour

OR

there are no employees currently working in this occupation at this work location

Note:
The wage range should be from the last 2 pay periods that have occurred within the 6 weeks prior to submitting the application.
6. Total number of TFWs (as a result of receiving a positive LMIA, formerly known as a labour market opinion or LMO) at the work location specified on this form:

7. Did you employ a TFW (as the result of receiving a positive LMIA) in the last two years, prior to December 31, 2013?
No

Yes

If YES did you provide all TFWs employed by you in the last two years with wages, working conditions and employment in an occupation that were
substantially the same as those that were described in the offer(s) of employment (and confirmed in the LMIA letter(s) and annexe(s))?
Yes

No

ESDC EMP5512 (2014-09-012) E

Page 2 of 11

8. Have you applied for and received a positive LMIA on or after December 31, 2013, and employed a TFW in that position?
No
Yes
If YES did you provide all TFWs employed by you, on LMIAs received on or after December 31, 2013, with employment in the same occupation as
described in the offer(s) of employment (and confirmed in the LMIA letter(s) and annexe(s)) and with substantially the same wages and working
conditions - but not less favourable than- those set out in that offer(s) of employment (and confirmed in the LMIA letter(s) and annexe(s))?
Yes

No

Note:
Employers should be aware that with recent changes to the Immigration and Refugee Protection Regulations, the look back period has changed from 2 to 6
years. However, this change is not retroactive and, therefore will not be fully implemented until January 2020.
9. Have you had an LMIA (formerly known as a labour market opinion or LMO) revoked within the previous 2 years from the date you submitted this application?
No
Yes
If YES was the LMIA revoked because you had provided false, misleading or inaccurate information in the context of a request for an opinion?
No

Yes

If yes, please provide the following details regarding this revocation:

System File Number:

Date (YYYY-MM-DD):

If the public policy considerations that justified the revocation are no longer relevant, please provide a detailed explanation:

10. Were any employees laid off in the past 12 months?

No
Yes

If yes, how many Canadians/permanent residents?

How many TFWs?

Reason(s) for layoff(s) and occupations affected:

11. Does your business receive support through any Government of Canada program (e.g. Work-Sharing Program)?
No
Yes If yes, name the program(s):

JOB OFFER INFORMATION

If you are requesting an LMIA to fill multiple jobs for the identical position/occupation, provide the job offer information only once. However, if there
are multiple jobs for different positions/occupations, use a separate application form for each unique position/occupation.
1. Job title:

2. Number of TFWs requested for this job offer

(same wage, job description, location, etc):

3. Expected Employment Duration:

4. Expected Employment Start Date (YYYY-MM-DD):

days

weeks

months

years

5. Provide the exact work location where the TFW will be working (number and street address):

6. City:

7. Province:

9. Describe the Main Duties of the Job:

ESDC EMP5512 (2014-09-012) E

Page 3 of 11

8. Postal Code:

10. Minimum educational requirements of the Job:

Doctorate/PhD

Doctor of Medicine

Masters degree

Bachelors degree

College level diploma/certificate

Apprenticeship diploma/certificate

Trade diploma/certificate

Secondary school

Vocational school diploma/certificate

No formal education requirement

Additional information:

11. Minimum experience/Skills Requirements of the Job:

12. Indicate the language requirement stated in the offer of employment.

The offer of employment does not require the ability to communicate in any specific language.
The offer of employment requires the ability to communicate orally in:
English

French

English or French

English and French

The offer of employment requires the ability to communicate in writing in:

English

French

English or French

English and French

The offer of employment requires the ability to communicate in a language other than English or French.
If this option is selected, identify the specific language needed and clearly describe why this is a bona fide employment requirement for performing
the duties associated with the employment. If insufficient space, attach a separate signed and dated sheet.

13. Wage in Canadian dollars and number of work hours:

per hour

Number of hours
per day

per year

Total number of
hours per week

Total number of
hours per month

Overtime hours rate of $

starts after

14. Benefits:
Disability insurance

hours of work per week.

Dental insurance

Pension

Extended medical insurance (e.g. prescription drugs, paramedical services,

medical services and equipment)

Vacation (if applicable):

Days:

(# of business days per year)

or
Remuneration:

(% of gross salary)

Other benefits (specify):

15. Are there any federal/provincial/territorial certification, licensing or registration requirements for this job?
No
Yes

If yes, what is the name of the certifying/licensing/registering body?

Will the TFW have all required certification, licensing, or registration prior to entering and starting work in Canada?
No

If no, please indicate the anticipated period of time to acquire all the required credential(s) after starting work in Canada:
days

Yes

weeks

months

If yes, the TFW must have proof that he/she already has all the required credential(s).

Note:
Securing the necessary documents to practice in Canada is the employer's and the worker's responsibility. CIC must be satisfied that the skilled workers are
capable of performing the employment being offered to them. CIC will check to ensure the skilled workers hold the required certification, or license to practice
in a regulated occupation in Canada. If the applicant is not certified or licensed, CIC will assess whether the applicant is likely to qualify for licensing/
certification when in Canada.
ESDC EMP5512 (2014-09-012) E

Page 4 of 11

16. Is the position part of a union?

No

Yes

If yes, what is the name of the union and the local?

Has the union been consulted about the hiring of a TFW?

No

If no, please explain.

Yes If yes, what is the position of the union? Provide details. Attach documentation, if available:

17. Have you attempted to recruit Canadians/permanent residents for this job?
No

If no, explain:

Yes

If yes, you must provide proof of recruitment (e.g. copy of advertisements and information to support where, when and for how long the
position was advertised).

In addition, if you advertised on the Job Bank (or the provincial/territorial equivalent), provide the order number:
18. What are the potential benefits to the Canadian labour market for offering this job to a TFW(s)?
Development or transfer of skills and knowledge
Direct job creation or retention of Canadians/
Filling a labour shortage
for the benefit of Canadians/permanent residents
permanent residents
Provide details:

19. Provide a rationale for the job offer you are making to the TFW(s) and describe how this will meet your employment needs:

20. Do you plan to hire or train Canadians/permanent residents for the position(s) for which you are requesting an opinion?
No

If no explain:

Yes

If yes, provide a brief description of the training plan:

ESDC EMP5512 (2014-09-012) E

Page 5 of 11

Other

21. Will you provide the temporary foreign worker with suitable and affordable accommodation?
No, but I will assist by doing the following:

If yes, please indicate the rent : CAD$

Yes

per week or

Per month and describe the type of accommodation:

SUMMARY OF RESULTS TO MEET MINIMUM RECRUITMENT AND ADVERTISEMENT REQUIREMENT

You must provide a brief summary of the results of the activities you conducted to meet the minimum recruitment and advertisement requirements to
apply for an opinion.
2. Number of Canadian/permanent resident applicants interviewed:
1. Number of applications/resumes received from Canadians/permanent
residents:
3. Number of Canadians/permanent residents offered the position:

4. Number of Canadians/permanent residents hired:

5. Number of job offers declined by Canadian/permanent resident applicants:

6. Number of Canadian/permanent resident applicants who were not qualified

for the job:

7. For each unsuitable Canadian/permanent resident applicant, provide an explanation as to why the candidate did not meet the requirements of the position, if
necessary, attach a separate sheet. However, do not provide the names of the candidates (e.g. applicant #1 poor references, applicant #2 unable to speak
English at a level to be able serve customers in a fast-paced restaurant).

TRANSITION TO A CANADIAN WORKFORCE

There are 2 possible paths for employers to transition to a Canadian workforce. The path that an employer must follow is determined by the wage
being offered to the TFW for the position, in relation to the provincial/territorial median hourly wage, based on Statistics Canadas Labour Force
Survey (2013).
Note:
This requirement is not applicable to employers who apply for on-farm primary agriculture positions such as: general farm workers, nursery and greenhouse
workers and harvesting labourers, skip to section Impacts on the Canadian Labour Market.
The provincial/territorial median hourly wages are as follows:
Alberta

$24.23

Nunavut

$29.96

British Columbia

$21.79

Ontario

$21.00

Manitoba

$19.00

Prince Edward Island

$17.26

New Brunswick

$17.79

Quebec

$20.00

Newfoundland and Labrador

$20.19

Saskatchewan

$21.63

Northwest Territories

$32.53

Yukon

$27.93

Nova Scotia

$18.00

Is the wage you are offering for the position at or above the provincial/territorial median hourly wage in the province/territory where the job is
located?
No

If no, complete the following Section A Cap for Low-wage Positions

Yes

If yes, skip to Section B Transition Plans for High-wage Positions

ESDC EMP5512 (2014-09-012) E

Page 6 of 11

A. Cap for the Low-wage Positions

Employers hiring TFWs and offering a wage that is below the provincial/territorial median hourly wage will be subject to a maximum 10% cap on the proportion of
these low-wage TFWs. The cap will be phased in over the next 2 years to provide employers who use the program with time to transition to a Canadian
workforce.
Employers that have a low-wage TFW workforce will be subject to an established cap, which is the lesser of their current percentage of TFWs in low-wage
positions, or:

30% as of June 20, 2014;

20% as of July 1, 2015; and

10% as of July 1, 2016.

Exemptions to the Cap Requirements

There are a few exemptions to the low-wage cap requirement. Please indicate if any of the following apply.
The business has fewer than 10 employees nationally, including the position to be staffed with TFWs;
The position on this application is truly temporary (e.g. emergency or warranty work);
The position on this application is for TFWs for a low-wage position(s) located in Quebec.

Establishing the Cap for the Specified Work Location

To begin, you need to know the percentage of TFWs that you employed in low-wage positions at the location specified on this application on June 20, 2014. You
will only need to calculate the cap once for the specified location. This calculation will let you know whether you are eligible to participate in the Program.
Employers who are above the cap should be aware that under established Ministerial Instructions, their Labour Market Impact Assessment (LMIA) applications
will not be processed.
On June 20, 2014, did you employ TFWs in low-wage positions, at the location specified on this application?
No

If no, you are subject to a maximum cap of 10% for low-wage TFWs.
Skip to the Section Calculating the Effect of hiring the TFWs requested on this LMIA on the cap.

Yes

If yes, have you calculated the cap for the location specified on this application?
Yes
No

I completed and submitted Schedule E for this location on a previous application

If no, complete Schedule E Establishing the Cap

Calculating the Effect of hiring the TFWs requested on this LMIA on the cap
The following questions will determine the effect that the TFWs being requested will have on the cap established for the job location specified on this LMIA.
1. [A] Total number of all the hours of work for all employees at the work location (including overtime and all positions staffed by

Canadians, permanent residents, current TFWs and all other workers on open work permits, student visas, etc.) for the
previous 4 consecutive weeks prior to the application being submitted. Do not include any current TFWs, whose work permits
are expiring within the next 90 days and will not be renewed:

2. [B] Calculate the average weekly hours worked, at the specified location:

A4=

3. [C] Total number of all the hours of work (including overtime) for all TFWs, who are currently employed in low-wage
positions, at the specified work location, for the previous 4 consecutive weeks, prior to the application being submitted.
Do not include any current low-wage TFWs, whose work permits are expiring within the next 90 days and will not be
renewed:
4. [D] Calculate the average weekly hours of work for the TFWs, who are currently employed in low-wage positions at the
specified work location:
C4=
5. [E] Provide the total weekly hours of the low-wage TFWs applied for on this application:
Note:
If the TFW(s) currently works in another low-wage position at this location their weekly hours should not be counted here as they
would be counted in question 3 above.
6. [F] Provide the total weekly hours of all low-wage TFWs you have applied to hire at this location that have not started work
(include pending LMIA applications and previously confirmed LMIAs)
7. [G] Calculate the percentage of low-wage TFWs:
8.

((D + E + F) (B + E + F)) x 100 =

Enter the cap that has been established for the specified work location (Refer to Schedule E, Box 7 under the
Establishing the Cap section):

B. Transition Plans for High-wage Workers

The Transition Plan is a mandatory requirement for all employers applying to hire TFWs, and who are offering a wage that is at or above the provincial/territorial
median hourly wage.
Employers meeting this criterion must complete Schedule C Employer Transition Plan.

RATIONALE FOR POSSIBLE EXEMPTION

If you would like to be considered for an exemption from having to provide a Transition Plan, you must complete this section and provide a
justification on how you meet the criteria indicated in the following question. Exemptions will be considered on a case by case basis.
1. What are the requirements of the position? Select all of the exemption criteria that apply to the position specified on this LMIA.
The position has a limited duration which means the job is time-limited and will no longer exist after the TFW leaves. The employment duration is:
1 to 120 days (e.g. emergency or warranty work)
more than 120 days to a maximum of 2 years (e.g. non-recurring project-based; position)
2. Employer Rationale:

ESDC EMP5512 (2014-09-012) E

Page 7 of 11

IMPACTS ON THE CANADIAN LABOUR MARKET

The questions in this section are to be completed by all employers. The response to these questions will assist the Program to determine the impact the
employment of temporary foreign workers will have on the Canadian labour market.
For the purpose of the Program:
Offshoring describes the relocation by a company of a business process from one country to another typically an operational process, such as
manufacturing, or supporting processes, such as accounting or IT services. More recently, offshoring has been associated primarily with technical and
administrative services supporting domestic and global operations from outside the home country, by means of internal (captive) or external (outsourcing)
delivery models.
Outsourcing describes the contracting out of an internal business process to a foreign or domestic third-party organization.
1. Will the entry of these temporary foreign workers lead to job losses, now or in the foreseeable future, for Canadians/permanent residents as a result of
lay-offs, outsourcing, offshoring or other factors related to utilizing temporary foreign workers?
No

Yes

If yes, provide a summary of the impact of hiring these temporary foreign workers, on your workforce (e.g. lay-offs, relocation) and the Canadian workforce more
generally.

2. Is this job offer related to an activity, contract or a subcontract that will facilitate outsourcing or offshoring?
No, go to the next section, under the heading FOREIGN WORKER INFORMATION
Yes

If yes, you must:

- complete the following questions (a to c) and
- have each employer with whom you have a contractual arrangement to provide services, complete a separate
Schedule B Impacts on the Canadian Labour Market.

a.) Provide a summary of the contractual arrangement between the employer of record and the company receiving services including (but not limited to)
information on: the purpose and scope of the project, the project timelines, the expertise required, and the number of Canadians/permanent residents
working on the project.

b.) Provide details on how Canadians/permanent residents with whom you have a contractual arrangement for services will be positively and/or negatively
affected by this arrangement? (e.g. lay-offs, relocation, displacement, promotions, restructuring, transfer of skills and/or knowledge)

c.) As part of this contractual arrangement, have you hired any TFW through any work permit-exempt or Labour Market Impact Assessment exempt
processing stream?
No
Yes

If yes, complete the following two questions (i.) and (ii.).

c-i.) Provide details on efforts in the past two years to hire and/or train Canadians/permanent residents for positions where a TFW has entered
under a work permit-exemption or Labour Market Impact Assessment-exemption?

c-ii.) Provide a summary of the impact of hiring these TFWs on Canadians/permanent resident workers within the company receiving services
under this contractual arrangement (e.g. lay-offs, relocation, etc.).

ESDC EMP5512 (2014-09-012) E

Page 8 of 11

FOREIGN WORKER INFORMATION

If you are hiring more than one TFW, use separate sheets to identify each worker coming to work for you in Canada.
If the TFW information is not available, leave this section blank.
Note:
After the positive LMIA letter and annexes have been issued, six months will be allocated to the:

employer to provide ESDC/Service Canada with the names of the TFWs; and

TFWs to submit an application for a work permit to Citizenship and Immigration Canada.
1. Surname (family name) as shown on the passport:

3. Gender
Male

2. Given Name(s) as shown on the passport:

4. Date of Birth (YYYY-MM-DD):

City:

Female

6. Citizenship(s):

5. Location of Residence Outside Canada:

Country:

7. If the TFW is currently in Canada, please indicate his/her location (city and province) and immigration status:
City:
Status:

Province:
Visitor

Temporary Foreign Worker

Refugee Claimant

Student

DECLARATION OF EMPLOYER
I am an unincorporated employer, sole proprietor or partnership.

Yes

No

If you answered "YES" to the above:

I understand that some provinces and territories operate, pursuant to agreements with the federal Department of
Citizenship and Immigration, Provincial Nominee Programs. I hereby consent to ESDC providing the personal
information contained in this request for a Labour Market Impact Assessment to the provincial/territorial
government(s) of the province(s) or territory(ies) where I carry on business to be used by the province(s) or
territory(ies) for the administration of their Provincial Nominee Programs

Yes
No

Check each box to declare that you comply (or will comply) with the statements below. If you are unable to check a
statement, Service Canada staff will request additional information, prior to issuing an opinion.
I certify that I am an employer who does not, on a regular basis, offer strip tease, erotic dance, escort services or erotic massages.
I understand that any LMIA application from an employer, who offers these services on a regular basis, will not be processed.
I certify that I am actively engaged in the business in respect of which the offer of employment is made and understand that I must
remain so during the period of employment for which the work permit is issued to the TFW(s).
I certify that the offer is consistent with my reasonable employment needs.
I certify that I am reasonably able to fulfill the terms of the employment offer.
I certify that I am compliant with, and will comply with the federal/provincial/territorial laws that regulate employment, and the
recruiting of employees, in the province/territory in which it is intended that the TFW(s) work and, if applicable, with the terms and
conditions of any collective agreement.
I certify that all recruitment done or that may be done on my behalf, by a third-party was, and will be, in compliance with federal/
provincial/territorial laws governing recruitment. I acknowledge and understand that I will be held accountable for the actions of any
third-party recruiting TFWs on my behalf.
I certify that I am aware of the published recruitment and advertising requirements of the TFW Program. I am, and will continue to
be, compliant with these requirements and I can provide proof upon request.
I certify that the employment of a TFW will not adversely affect the settlement of any labour dispute in progress or the employment
of any person involved in the dispute, should there be an ongoing or pending labour dispute at my business. I will inform Service
Canada in the case one should develop.
I will comply with the prevailing wage requirements and I agree to review and adjust, when applicable, the TFW(s) wages, at least
annually, to ensure he/she continues to receive the prevailing wage for the occupation and region where he/she is employed.

ESDC EMP5512 (2014-09-012) E

Page 9 of 11

I certify that I will make reasonable efforts to provide a workplace that is free of abuse which includes physical, sexual,
psychological or financial abuse.
I certify that I will provide the TFW(s) with employment in the same occupation as that set out in the TFWs offer of employment
and with wages and working conditions that are substantially the same as but not less favourable than those set out in the
LMIA letter and annex A.
I have signed and enclosed a copy of the employment contract related to the job offer referred to in this LMIA application. I certify
that this offer of employment meets all Program requirements. The terms and conditions in the offer, including the wages, working
conditions, job duties and any benefits are (or will be adjusted to be) the same as those that will be described in the LMIA letter
and annexes.
I will retain a copy of the contract, related to the offer of employment, signed by all parties. I understand and agree that ESDC may
request a copy during an employer compliance review or an inspection.
I will pay all transportation costs for the TFW(s) to travel from their country of residence to the location of work in Canada and for
the return transportation to their country of residence. If the TFW is already in Canada, I will pay all transportation costs from their
residence in Canada to the location of work in Canada, and for the return transportation to their country of residence. I will not
recover, directly or indirectly, any of these costs from any TFW(s).
I will arrange and pay for private health insurance for the TFW(s), which is similar to provincial/territorial health care coverage, until
he/she is eligible for provincial/territorial health care insurance coverage (where applicable) and will not recover these costs from
the TFW.
I am in good standing with the applicable workers compensation program and I will register the TFW(s) under the appropriate
provincial/territorial workers compensation/workplace safety insurance plans, where available, or purchase, on-the-job injury or
illness insurance that provides the TFW(s) with protection similar to the one offered by the applicable provincial/territorial law. I will
not recover these costs from the TFW.
I agree that I will not recover any costs, directly or indirectly, associated with seeking for an LMIA from any TFW(s).
I acknowledge and understand that for a period of six years from the first day of employment of the TFW(s), I may be subject to an
inspection and I will retain any documents that relate to the LMIA application and the terms and conditions of the LMIA and
annexes.
If required, I will give all reasonable assistance to the officer conducting the inspection. I will attend interviews and on-site
inspections, answer questions, provide information and documentation that relate to the conditions I have agreed to, pertaining to
the LMIA letter and annexes.
I understand that should an on-site inspection be required for verification of compliance with the conditions stated on the LMIA
letter and annexes, that the inspections may take place at any premises or location where the TFW(s) perform(s) work and any
premises or place that the employer has provided to the TFW(s) as accommodations.
I will provide Service Canada with the names of the TFW(s) I intend to employ within six months from the date on the LMIA letter.
I declare that the employment of the TFW(s) is likely to have a positive or neutral effect on the Canadian labour market and will not
lead to job loss or reduction in work hours for any Canadian or permanent resident during the period of employment for which the
work permit is issued.
I agree to pay the total fee indicated in the Labour Market Impact Assessment Application - Processing Fee Payment section,
either by credit card or certified cheque/money order. I also acknowledge that if I do not submit my payment, my LMIA application
will not be processed. This attestation and the requirement to pay the processing fee are NOT applicable to employers who meet
the definition of on-farm primary agriculture and are hiring TFWs in the NOC codes: 8431, 8432 and 8611.

ESDC EMP5512 (2014-09-012) E

Page 10 of 11

SIGNATURE OF EMPLOYER
The individual signing this form must have authority for either the hiring or financial decisions of the organization (e.g. owner,
franchisee, general manager, or senior executive such as VP Human Resources).
I have read and I understand the Personal Information Collection Statement found at the beginning of this application.
I declare that the information provided in this Labour Market Impact Assessment application is true, accurate and complete.

Signature of Employer

Printed Name of Employer

Title of Employer

Date (YYYY-MM-DD)

A person, who contravenes a provision set out under sections 126 or 127 of the Immigration and Refugee Protection Act
(misrepresentation), could be liable to a fine or to imprisonment, or to both. Also, providing inaccurate information, in the context of
this application, may lead to an administrative penalty such as being ineligible to access the Program for a period of two years.

DOCUMENTATION REQUIRED
The boxes with check marks indicate the required documents that should be included with the application.
If a required document is not attached, please explain:

Documentation Required
Proof of recruitment (e.g. copy of advertisement and information to support where, when and for how long the position was advertised)

Business registration or legal incorporation documents (if first LMIA application)

Provincial/municipal business license (where applicable and if first LMIA application)

Canada Revenue Agency:

T2 Schedule 100 Balance Sheet Information (for corporations only 2 most recent returns filed)
T2 Schedule 125 Income Statement Information (for corporations only 2 most recent returns filed)

Only required if this is the employers first LMIA application. Does not apply to film and entertainment
Provincial/territorial workplace safety and insurance (e.g. workers compensation board) clearance letter/certificate

Commercial lease agreement (where applicable and if first LMIA)

Provincial documentation requirements (for the provinces noted below):

ALBERTA - Employment Agency Business Licence (Alberta's Fair Trading Act) if applicable
BRITISH COLUMBIA - Employment Agency License (British Columbia's Employment Standards Act) if applicable
MANITOBA - Certificate of Registration (Manitoba's Worker Recruitment and Protection Act)
NOVA SCOTIA - Employer Registration Certificate (Labour Standards Code)
SASKATCHEWAN Employer Registration Certificate (The Foreign Worker Recruitment and Immigration Services Act)
Note:
In some cases the province may not provide a physical document but rather post the names of registered/certified employers on a
website.

Send Application and all Supporting Documentation:

Employers must sign and send the completed application and all required documentation to the Service Canada Centre responsible for processing applications
in their area.
A list of LMIA Processing centres is available on the ESDC website: www.esdc.gc.ca/eng/jobs/foreign_workers/scc.shtml
Note:
A complete application means that employers have:

filled out all of the fields in all of the necessary forms;

included all of the required documentation;

signed the forms where required; and

submitted the fee payment with the application.

If an application is submitted and it is not complete, Service Canada staff will inform the employer that the application will not be processed. Incomplete
applications and supporting documents submitted with the application will not be retained or returned to the employer. As a result, employers are advised to
submit copies, not original documents.
Page 11 of 11
ESDC EMP5512 (2014-09-012) E

Employment and
Social Development Canada

Emploi et
Dveloppement social Canada

PROTECTED WHEN COMPLETED - B

For office use only

LABOUR MARKET IMPACT ASSESSMENT PROCESSING FEE PAYMENT

Employers must pay a processing fee for each position requested, except applications that involve on-farm primary agriculture occupations such as general
farm workers, nursery and greenhouse workers and harvesting labourers (specifically NOC codes 8431, 8432 and 8611).
The total processing fee, where applicable, must be paid before the employers LMIA application can be processed.
Step 1 Complete employer information section:
Employer Business Name:
Canada Revenue Agency Business Number:
(First 9 digits are mandatory for Canadian employers)
Step 2 Calculate total labour market impact assessment processing fee in Canadian dollars:
Number of positions requested

X $1,000 = TOTAL processing fee payment of $ CAD

Step 3 Select method of payment:

Certified cheque or money order (postal or bank) made payable to the Receiver General for Canada
Credit card (Visa, MasterCard, American Express)

For payment by credit card, complete and sign this section

CREDIT CARD INFORMATION AND PAYMENT AUTHORIZATION

Name of cardholder (as it appears on the credit card):

Employer primary contact name:

Credit card type:

Credit card number:

Visa

MasterCard

Expiry date:
MM

American Express

YYYY

Enter the card security/card verification value code (CVV) (a three or four digit number found on the back or front of the credit card):
AUTHORIZATION:
I authorize ESDC/Service Canada in the name of the Receiver General for Canada to charge

$ CAD to my credit card

This is permission for a single transaction, and does not provide authorization for any additional charges.
Date:

Signature of cardholder:

YYYY

MM

DD

Send this form to Service Canada only

NOTE:
Refunds will only be provided if a fee was collected in error (e.g. an incorrect fee amount was processed). There will not be refunds in the event of a negative
labour market impact assessment since the fee covers the process to assess an application and not the outcome.

ESDC EMP5576 (2014-06-005) E

Page 1 of 1