大西洋移民项目豁免LMIA工签申请承诺IMM5654E翻译中英文对照

表格版本：IMM 5654 (01-2021) E
如果申请表版本过期，希望朋友们能留言提醒，会及时更新。

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UNDERTAKING FOR AN APPLICATION FOR A WORK PERMIT EXEMPTED
FROM A LABOUR MARKET IMPACT ASSESSMENT (LMIA) AS PART OF
THE ATLANTIC IMMIGRATION PILOT (AIP)

大西洋移民项目豁免LMIA工签申请承诺

本文网址二维码

A – AIP CANDIDATE A部分 —— 大西洋移民项目候选者

Principal applicant - Family name (surname) 主申请人 —— 姓氏

Given name(s) 名字

FOR IRCC USE ONLY IRCC专用

Gender 性别

F - Female（女）
M - Male（男）
X - Another gender（其他性别）

注意：如果你选择性别为 F 或 M，则必须与自己提交申请时的提供的护照或旅行文件上所标注的性别一致。如果如果选择的性别标识符是 X，则应匹配等效的非男女二元选项（equivalent non-binary option）。

（时光在路上(www.timezls.com) 注：关于X 性别的背景资料，请参考如下文章：

）

Family status 家庭状况

Country of citizenship 国籍

B – AIP PROGRAM B部分——大西洋移民项目

Province of destination 目的地省份

AIP program 大西洋移民项目

Atlantic High-Skilled Program 大西洋高技能项目
Atlantic Intermediate-Skilled Program 大西洋中等技能项目
Atlantic International Graduate Program 大西洋国际毕业生项目

C – EMPLOYER INFORMATION C部分 —— 雇主信息

Business operating name 企业名称

Business mailing address: 企业通信地址

Street and number 街道和街道号
Apt. / Unit 公寓/楼宇的地址
City 城市
Province 省
Postal code 邮编

Telephone number 电话号码

Cell number 手机号

Email address 电邮地址

Company representative: 公司代表

Family name (surname) 姓氏
Given name(s) 名字
Title 职务

D – UNDERTAKING AND DECLARATION D部分 —— 承诺和声明

Important: You must read, complete and sign this section. 重要提醒：你必须阅读、填写并在此部分签字。

I am applying for a one year, LMIA-exempt work permit under the Atlantic Immigration Pilot. 我正在申请为期一年的工签，该工签在大西洋移民项目中红可豁免劳动力市场影响评估（LMIA）

I have a valid job offer from an employer designated by (Name of province) to participate in the Atlantic Immigration Pilot, and a letter from (Name of province) confirming that an Endorsement Application has been signed by me and submitted by my prospective employer to the (Name of province)

大西洋移民项目中，我有来自（省份名称）指定雇主的有效工作offer，而且有（省份名称）的支持信，该支持信我已签字，我将来的雇主已经向（省份名称）提交该支持信。

I undertake to:我承诺：

Apply for permanent residence under one of the three programs of the Atlantic Immigration Pilot no more than 90 days after having submitted an application for a work permit to Immigration, Refugees and Citizenship Canada; 通过大西洋移民项目下三类移民项目中任一项目提交工签申请后，会在90天内向IRCC申请永久居留。
Reside within (Name of province) throughout the period of temporary employment; 工作期间居住在（省份名称）
Work for the employer specified on the work permit; and 为工签上特定的雇主工作，并且
Report any change in employment to IRCC and (Name of province) 如果就业方面有任何变动，将会向IRCC和（省份名称）汇报。

Further, 另外，

□ I declare that the information provided is to the best of my knowledge true, complete and accurate. 我声明，尽我所知，我所提供的信息真实、完整、准确。
□ I am compliant with the Immigration and Refugee Protection Act and the Immigration and Refugee Protection Regulations. 我遵守《移民及难民保护法》和《移民及难民保护条例》
□ To the best of my knowledge I meet the program requirements of the Atlantic Immigration Pilot. 尽我所知，我满足大西洋移民项目的要求
□ I consent to the collection and disclosure of the information contained herein, including for monitoring and evaluation purposes. 我同意此处包含的信息被收集和披露，包括监测和评估目的。

I confirm that I understand that if I have made a false declaration or have otherwise provided false or misleading information or have undertaken concealment of a material fact, this application could be rejected. I further confirm that I understand that providing such false or misleading information or concealing material facts could be an offence and/or constitute non-compliance under the Immigration and Refugee Protection Act. I understand that any false statements or concealment of any material fact may result in, but is not limited to, the following consequences: 我确认对此了解：如果我提供错误声明、提供错误或不实信息、或者隐瞒事实，此申请将会被拒。我也同样确认自己对此了解：根据《移民及难民保护法》，提供错误或误导信息、隐瞒事实，将会构成犯罪或/和违约。我对此了解：任何错误陈述或对事实的隐瞒可能导致，但不限于，下列后果：

Refusal of the associated work permit under the Atlantic Immigration Pilot. 大西洋移民项目工签被拒。
Refusal of any application for permanent residence made under the Atlantic Immigration Pilot. 大西洋移民项目永久居留申请被拒。

I also understand that should I be found to be inadmissible for misrepresentation under section 127 of the Immigration and Refugee Protection Act, I may be barred from entering Canada for a period of two years following a final determination of my inadmissibility or, if this determination is made in Canada following my removal from Canada. 我也对此了解：根据《移民及难民保护法》第127节规定，如果被发现不实陈述，我将被局入境，被拒入境裁决生效后，或者该裁决在我被驱逐出境后生效，可能在接下来2年内禁止入境。

Name of applicant 申请人姓名

Signature of applicant 申请人签字

Date (YYYY-MM-DD) 日期（年-月-日）

Privacy Statement 隐私声明

Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection Act (IRPA). The personal information provided will be used for the purpose of processing an application. The personal information provided may be disclosed to other federal government institutions, law enforcement bodies, provincial/territorial governments and/or foreign governments for the purpose of validating identity, information, eligibility, and admissibility.

Personal information may also be used for other purposes including research, statistics, program and policy evaluation, internal audit, compliance, risk management, subsequent program eligibility, and strategy development and reporting.

Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction of their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC’s Personal Information Bank – IRCC PPU 054.

根据《移民及难民保护法》授权，陈述信息将会被IRCC收集。所提供的个人信息将用于处理申请。用于验证身份、信息、资格和是否可以入境，可能会向其他联邦政府机构、执法机构、省/地区政府和/或外国政府披露所提供的个人信息。

个人信息也可用于其他目的，包括研究、统计、项目和政策评估、内部审计、合规、风险管理、后续项目资格以及战略制定和报告。

未能完整填写表格可能会导致申请的延迟或不予处理。《隐私法》赋予个人获取、保护和更正个人信息的权利。如果你对 IRCC 处理你个人信息的方式不满意，可以行使向加拿大隐私专员办公室投诉的权利。个人信息的收集、使用、披露和保留，在 IRCC 的个人信息库 – IRCC PPU 054中有进一步说明。

时光在路上最后编辑于：2022年3月8日