SUBJECT: R204(c) Provincial Selection of Temporary Foreign

Worker

The Province of Qubec is seeking to use its authority under Section [section reference] of the
Temporary Foreign Worker Annex of the [name of Immigration Agreement] to select the following
individuals for temporary employment.

[List selected individuals including last name, first name, date of birth and country of
citizenship or permanent residence. If necessary, indicate that a list is attached]

Last Name First Name Date of Country of List?

Birth Citizenship

McClure- Pierre Aug-17-1970 Yes

Legrand

[Details of the job: name of the employer, address of the employer, job description and main tasks
to be performed, start and end dates the individual is required]

Employer Employer Job Main Start Date End Date

Name Address Description Tasks

The Province of Qubec believes that the presence of this worker in [province] will support
economic activity and growth within the province. Furthermore, we can confirm that we find the
above-mentioned employer to be reputable and genuine. (meets the standards of genuineness set out
in the new regulations)

[Additional information:
- details i.e. date and specifics of the selected workers expected entry, travel mode and
port of entry or mission where h/she intends to apply for a work permit;
- information on accompanying spouse and/or dependents (if applicable);
- other pertinent information that Citizenship and Immigration Canada or port of entry
officials should be made aware of.]
 Date Travel mode Port of entry Info on Other
accompanying pertinent info
spouse
January 10, 2018 Airplane N/A Flight #6654

[Contact Person: Name, address, phone number and email]

Name Address Phone number Email

Immigration Officer Instructions

Reference FW1 manual Section 5.27 (Agreements); exemption code T13 applies; TFW-PS is to
be noted in visible Remarks.
Note: Unlike the TFWs supported through the Provincial Nominee Program (TFW-PNP), the
provincially selected worker (TFW-PS) does not require a nomination certificate.