You are on page 1of 8

Employment and

Social Development Canada

Please Print

Emploi et
Dveloppement social Canada

PROTECTED WHEN COMPLETED - B

APPLICATION FOR A LABOUR MARKET IMPACT ASSESSMENT


SEASONAL AGRICULTURAL WORKER 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 TFWs 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.
THIRD-PARTY INFORMATION
1 Are you appointing a third-party to represent you in completing this LMIA application form or to provide advice in an immigration process?
No

2 Name of third-party representative:

If yes, complete Schedule A Third-party representative


3 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

EMPLOYER INFORMATION

Check one:
Direct Arrival

Direct Replacement

Double Arrival

Double Transfer

Replacement Transfer

Transfer

(Initial request for SAWP worker(s) from abroad)

(Request for worker(s) to transfer back to


original employer from a second employer)

(Request to replace worker(s) who returned home


prior to the expected departure date)

(Request to replace worker(s) from within Canada)

(Request where worker(s) go home and return


to the same employer in the same program year)

(Request to transfer worker(s) from one


employer to another within Canada)
Original System File #
Original Employer:

Check box to indicate that substitute workers WILL NOT be accepted in situations where previously identified workers are not available.
NOTE: TFWs cannot be transferred to another employer or shared without approval as per the SAWP policy. Transferring or sharing TFWs informally
contravenes to sections 124(1)(c) and 125 of the Immigration and Refugee Protection Act (IRPA) and is punishable by a fine of up to $50,000 and
imprisonment.
1 Employer ID # (if applicable)

4 Employer Legal Name

ESDC EMP5389 (2016-01-016) E

2 Canada Revenue Agency Business Number


(First 9 digits are mandatory for Canadian Employers)

3 Employer Business Name

5 Employer Mailing Address (including location as determined by the 911 system)

Page 1 of 8

and/or

6 City

7 Province/State

10 Business Telephone Number

8 Country

9 Postal/Zip Code

11 Employer Business Address (if different than mailing address)

12 City

13 Province/State

14 Postal/Zip Code

16 Website Address

15 Country

17 Date Business Started (yyyy-mm-dd)

18 Describe the main business activity:

19 Primary Contact Name


First

20 Job Title
Middle

21 Telephone Number

Last
22 Alternative Telephone Number (e.g. cell phone)

Extension

23 Fax Number

Extension

24 E-mail Address

25 Preferred Official Language of Correspondence


English

French

Alternative Contact (please note that if you designate an alternate contact, he/she assumes responsibility for the business for the purpose of
applying for a Labour Market Impact Assessment with ESDC)
1 Contact Name
First

2 Job Title
Middle

3 Telephone Number

Last
4 Alternative Telephone Number (e.g. cell phone)

Extension

5 Fax Number

Extension

6 E-mail Address

7 Preferred Official Language of Correspondence


English

French

BUSINESS DETAILS
1 Total # of Canadian seasonal agricultural workers employed:
This year/
season

Last year/
season

2 Total # of temporary Foreign seasonal agricultural workers requested:


This year/
season

Last year/
season

3 If the number of workers, which includes Canadian citizens, permanent residents and TFWs is different from last year/season, explain:

4 Did you employ a temporary foreign worker in the last two years, prior to December 31, 2013?

No

Yes

If YES did you provide all temporary foreign workers 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

5 Have you applied for and received a positive LMIA on or after December 31, 2013, and employed a temporary foreign worker in that position?

No

Yes

If YES did you provide all temporary foreign workers 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 lookback period has changed
from 2 to 6 years. However, this change is not retroactive and therefore will not be fully implemented until January 2020.
ESDC EMP5389 (2016-01-016) E

Page 2 of 8

6 List crops/commodities, acreage and harvesting method for the job that will be performed by TFWs:

Crop/Commodity

Acreage (if applicable)

Method Harvested
Fully automated
Semi-automatic
Hand harvested
Job does not require harvesting
Fully automated
Semi-automatic
Hand harvested
Job does not require harvesting

JOB OFFER INFORMATION


Please provide details for each job offer. If this application covers more than one job offer and if the offers cover more
than one job title, you must complete a separate sheet providing the details of the offer(s) under each job title.
1 Job Title

2 Total # of workers requested for this job:

3 Source Country

4 Describe the Main Duties/Requirements of the job (In addition to duties, please detail any experience/skill requirements):

5 Primary Work Address (including location as determined by the 911 system)

NOTE: Additional addresses where the TFWs will be working must be provided on a separate sheet.
6 City

7 Province

8 Postal Code

9 County/District/Region

13 Postal Code

14 County/District/Region

10 Secondary work Address (which includes location as determined by the 911 system)

11 City

12 Province

15 Language requirements: Indicate the language requirement needed for this job. If you indicate a language that the temporary foreign worker does not speak, the
application will be refused by Citizenship and Immigration Canada, even if the worker is suitable for the position.
Oral:

English

English or French

French
Other

Written:

English

English or French

English and French

French

English and French

None

Other

None

If the language required for the job is other than English and/or French, please identify the language requirement and provide an explanation:

16 Wage offered to the TFWs in Canadian dollars and number of hours of work
NOTE: Employers must offer the same wage rate set by ESDC/Service Canada for occupations under the National Commodity List. In a unionized environment,
employers must offer the Temporary Foreign Worker the wage rate as established under the collective bargaining agreement.
per hour: $

other/piecework: $
*Provide description of other/piecework:

Overtime rate per hour of $

starts after

hours of work per week as per provincial/territorial legislation.

Check box if not applicable


NOTE: Employers can hire TFWs for a maximum duration of 8 months, between January 1 and December 15, provided they are able to offer a minimum of 240
hours of work within a period of 6 weeks or less.

ESDC EMP5389 (2016-01-016) E

Page 3 of 8

17 Deductions
Transportation costs: Deduction from the TFWs' pay (applicable in all provinces/territories except in British Columbia) as per the SAWP employment contract.

. Check box if work location is in British Columbia

Total deduction for period of employment:$

Check box to indicate that the total deduction for the coming year is currently unknown, and that you will be deducting
from the TFWs pay the amount indicated in the employment contract for the coming year, once the information is
available on the departmental website
Check box if you do not want to deduct the transportation cost
Accommodation costs: Deduction from the TFWs' pay (applicable in British Columbia only) as per the SAWP employment contract.

. Check box if work location is in a province/territory other than British Columbia

Total deduction for period of employment: : $

Check box to indicate that the total deduction for the coming year is currently unknown, and that you will be deducting
from the TFWs pay the amount indicated in the employment contract for the coming year, once the information is
available on the departmental website
Check box if you do not want to deduct the accommodation costs
Utility costs: Daily deduction from the TFWs pay (applicable only in provinces authorizing this deduction) as per the SAWP employment contract:
Total deduction for period of employment:$
. Check box if not applicable

Check box to indicate that the total deduction for the coming year is currently unknown, and that you will be deducting
from the TFWs pay the amount indicated in the employment contract for the coming year, once the information is
available on the departmental website
Check box if you do not want to deduct the utility costs
NOTE: TFWs must work for a minimum of 4 hours in any given day in order to be subject to this deduction.

Meals costs: Daily deduction from the TFW's pay: $

. Check box if not applicable

, and number of daily meals provided

Health insurance costs (Great-West Life Assurance Company):


Daily deduction from the TFWs pay: $

(applicable for Mexican TFW's only). Check box if not applicable

Work permit processing fee: Deduction from the TFW's pay as per the SAWP employment contract.
Total deduction: $

. Per pay: $

. Check box if not applicable

Quebec Certificate of Acceptance (CAQ) fee:


Total deduction from the TFW's pay as per the SAWP employment contract: $
or indicate the amount to be deducted per pay: $

. If total amount is to be deducted from the final pay, check box

. Check box if not applicable

18 Benefits:

Disability insurance
Dental insurance

Extended medical insurance (e.g. prescription drugs,


paramedical services,medical services and equipment)
Pension

Check box if not


applicable

Vacation (if applicable):


Number of paid vacation days per year:
or

Remuneration: $

(% of gross salary)

as per provincial/territorial legislation.

Check box if not applicable

19 Other benefits (specify):

Check box if not applicable


20 Will you provide a weekly recognition payment of $4 up to a maximum of $128, to the TFWs who have previously worked for 5 or more consecutive years at your place of
employment?
Yes
No

Check box if the TFWs you are hiring have not worked 5 or more consecutive years at your place of employment
21 Advertisement and Recruitment
Describe methods used to recruit Canadian citizens/permanent residents for this job :

Provide dates and duration of advertisements:

Job Bank (or provincial/territorial equivalent) Job number:


Results of recruitment efforts:

ESDC EMP5389 (2016-01-016) E

Page 4 of 8

Total number of applications received from Canadian/permanent resident candidates:


Number of Canadian/permanent resident applicants interviewed:
Number of Canadian/permanent resident applicants who were offered a position:
Number of job offers declined by Canadian/permanent resident applicants:
Number of Canadian/permanent resident applicants who did not qualify for the job and reasons:

NOTE: Supporting documentation such as advertisements in local and national newspapers, or on recognized Internet job sites, and in professional publications,
recruitment drives, as well as proof of participation in job fairs, etc., may be requested by HRSDC/Service Canada.
22 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 temporary foreign worker?
No

If no, please explain:

Yes

If yes, what is the position of the union? Provide details and documents, if available:

23 Is there a labour dispute in progress?


No

Yes

If yes, please provide details:

24 Seasonal Housing Approval (If prior year is attached, proof of housing for the current year must follow as soon as it is available):
Proof of Seasonal Housing Inspection:
Prior or current year attached

or

Previous year's inspection attached and current year to follow by

(yyyy-mm-dd)

(NOTE: current year's inspection must be submitted as soon as possible)


Employers must provide TFWs with free suitable housing (except for British Columbia) either on-farm (e.g. bunkhouse) or off-site (e.g. commercial establishment).
A copy of the signed contract between the employer and the facility is required for off-site housing (except in cases where the employer is the owner of the dwelling).
Employers must provide proof that the on-farm or off-site housing has been inspected by the appropriate provincial/municipal body or by an authorized private inspector
with appropriate certifications from the relevant level of government. As proof, employers can submit a copy of the housing inspection report from the previous year, with
an expected date for the current year.
25 Physical address of housing provided to the TFWs (including location as determined by the 911 system):

26 City

27 Province

28 Physical address of a second housing provided to the TFWs (including location as determined by the 911 system), if applicable:

NOTE: Addresses of additional housing provided to the TFWs must be provided on a separate sheet.
29 City

30 Province

Arrival Dates for SAWP Workers with this Job Title


Number of Named Workers

Number of Unnamed Workers


(if applicable)

Requested Arrival Date


(yyyy-mm-dd)

Anticipated Departure Date


(yyyy-mm-dd)

Important Notes:
- Workers are hired according to the current year's Seasonal Agricultural Worker Program policies and contract terms..
- It is the responsibility of the employer to sign a copy of the current employer-employee contract for the employment of SAWP workers in Canada. Employer must
submit a copy of the contract to Service Canada with this application.

ESDC EMP5389 (2016-01-016) E

Page 5 of 8

TEMPORARY FOREIGN WORKER INFORMATION (if available)


Add the names of the TFWs hired on a separate sheet or on the page entitled Annex A - TEMPORARY FOREIGN WORKER INFORMATION found on
this application. If the names of the TFWs have not been identified yet, leave this section blank.
NOTE:
ESDC/Service Canada must be provided with the names of the TFWs hired within 2 months after their arrival in Canada.
TFWs have 6 months from the date of issuance of the positive LMIA letter to submit their work permit applications to CIC.
1 Family Name as Shown on the Passport

3 Gender
Male

2 First Name(s) as Shown on the Passport

4 Date of Birth (YYYY-MM-DD)


Female

5 Location of Residence Outside Canada:

6 Citizenship(s)

City:
Country:

7 If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

Visitor

Province:

Temporary foreign worker

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

YES

NO

Check each box to declare that you comply (or will comply) with the statements below:

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 temporary foreign worker(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 temporary foreign worker(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
foreign workers on my behalf.
I certify that I am aware of the published recruitment and advertising requirements of the Temporary Foreign Worker Program. I am, and will
continue to be, compliant with these requirements and I can provide proof upon request.
I certify that there is no ongoing or pending labour dispute at my business, and I will inform Service Canada in the case that one should develop.
I will comply with the prevailing wage requirements and I agree to review and adjust, when applicable, the temporary foreign workers wages to
ensure they continue to receive the proper wage, which is defined as the highest rate from among - the National Commodities Wage Tables for
the specified commodity, the provincial/territory minimum wage, or the rate I am paying the Canadian workers I employ to perform the same type
of work at the same work location as the temporary foreign workers.
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 temporary foreign worker(s) with employment in the same occupation as that set out in the temporary foreign
workers 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 Agreement for the Employment in Canada of Seasonal Agricultural Workers (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 agree to pay the air transportation costs for the temporary foreign workers as stipulated in the Agreement for the Employment in Canada of
Seasonal Agricultural Workers (the employment contract). In all provinces and territories, except British Columbia, a part of this cost can be
deducted from the temporary foreign workers' wage, up to a maximum amount, as stipulated in the employment contract.
I will deduct the cost of private complementary health coverage from the temporary foreign workers wage, for temporary foreign worker(s) from
Mexico only, as stipulated in the employment contract and will pay, on behalf of the temporary foreign worker, the private complementary medical
organization selected by the Mexican Government.
I am in good standing with the applicable workers compensation program and I will register the temporary foreign worker(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 temporary foreign worker(s) with protection similar to the one offered by the applicable provincial/territorial law. I will not recover
these costs from the temporary foreign worker.
I agree that I will not recover any costs, directly or indirectly, associated with seeking for an LMIA from any temporary foreign worker(s).
I acknowledge and understand that for a period of six years from the first day of employment of the temporary foreign worker(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.

ESDC EMP5389 (2016-01-016) E

Page 6 of 8

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 this 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 temporary foreign worker(s) perform(s) work and any premises or place
that the employer has provided to the temporary foreign worker(s) as accommodations.
I will provide Service Canada with the names of the temporary foreign worker(s) I intend to employ within six months from the date on the LMIA
letter.
I agree to pay upfront the processing fees for the temporary foreign workers work permit. I will deduct this cost from the foreign workers wage, as
stipulated in the employment contract.
I agree to provide suitable accommodation to the temporary foreign worker(s) without costs in all provinces/territories, except in British Columbia,
where a part of this cost can be deducted from the temporary foreign workers wage, up to a maximum amount, as stipulated in the employment
contract.
I agree to provide Service Canada with a housing (on-farm or off-site) inspection report conducted by the appropriate provincial/territorial or
municipal authority or by an authorized private inspector. I understand that a copy of the inspection report from the previous year may be accepted
as part of this LMIA application; however I must commit to submit a report for the current year to Service Canada prior to the arrival of the
temporary foreign workers in Canada.
I agree to follow the Temporary Foreign Worker Program transfer clauses, as stipulated in the employment/transfer contract, when a temporary
foreign worker is transferred between Seasonal Agricultural Worker Program employers.

SIGNATURE OF EMPLOYER
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

Name of Employer (Please Print)

Title of Employer

Date (YYYY-MM-DD)

INFORMATION FOR EMPLOYERS


Employers in all provinces/territories (except those in Quebec) or their third-party representatives, must submit the completed
application and required supporting documentation to the Service Canada Centre of Specialization at:
Service Canada Centre
Seasonal Agricultural Worker Program Centre of Specialization
5 Queensway East
Simcoe, ON N3Y 5K2
Fax: 519-426-0362 or
Fax (toll free): 1-855-221-1601
To pay for work permit fees: Phone
1-866-431-7297 (toll-free)
Employers in the Province of Quebec, or their third-party representatives, must submit the completed application and required
supporting documentation to:
Service Canada
Temporary Foreign Worker Program
1001 de Maisonneuve Boulevard East
4th floor
Montreal, QC H2L 5A1
Fax: 514-877-3680

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.
ESDC EMP5389 (2016-01-016) E

Page 7 of 8

Annex A ADDITIONAL TEMPORARY FOREIGN WORKER INFORMATION


1.
Family Name as Shown on the Passport

Gender
Male

Date of Birth (YYYY-MM-DD)

First Name(s) as Shown on the Passport

Location of Residence Outside Canada:

Citizenship(s)

City:

Female

Country:

If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

Visitor

Province:

Temporary foreign worker

2.
Family Name as Shown on the Passport

Gender
Male

Date of Birth (YYYY-MM-DD)

First Name(s) as Shown on the Passport

Location of Residence Outside Canada:

Citizenship(s)

City:

Female

Country:

If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

Visitor

Province:

Temporary foreign worker

3.
Family Name as Shown on the Passport

Gender
Male

Date of Birth (YYYY-MM-DD)

First Name(s) as Shown on the Passport

Location of Residence Outside Canada:

Citizenship(s)

City:

Female

Country:

If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

Visitor

Province:

Temporary foreign worker

4.
Family Name as Shown on the Passport

Gender
Male

Date of Birth (YYYY-MM-DD)

First Name(s) as Shown on the Passport

Location of Residence Outside Canada:

Citizenship(s)

City:

Female

Country:

If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

Visitor

Province:

Temporary foreign worker

5.
Family Name as Shown on the Passport

Gender
Male

Date of Birth (YYYY-MM-DD)

First Name(s) as Shown on the Passport

Location of Residence Outside Canada:

Citizenship(s)

City:

Female

Country:

If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

Visitor

Province:

Temporary foreign worker

6.
Family Name as Shown on the Passport

Gender
Male

Date of Birth (YYYY-MM-DD)


Female

First Name(s) as Shown on the Passport

Location of Residence Outside Canada:

Citizenship(s)

City:
Country:

If the temporary foreign worker is currently in Canada, please provide the location (City and Province) and their immigration status:
City:

ESDC EMP5389 (2016-01-016) E

Visitor

Province:

Page 8 of 8

Temporary foreign worker