Live-in Caregiver: Employer Declaration of Hours Worked (IMM 5634)
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Live-in Caregiver: Employer Declaration of Hours Worked [IMM 5634] (PDF, 0.9 MB)
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Live-in Caregiver – Employer Declaration of Hours Worked (IMM 5634)
Who must fill out this application form?
This form must be completed and signed by your employer(s) and submitted with your application for permanent residence if you choose “Option 2” for calculating whether you have met the employment requirement to be eligible for permanent residence as live-in caregiver.
What is Option 2?
“Option 2” is defined as a total of 3,900 hours (within a minimum of 22 months which may include a maximum of 390 hours of overtime) of authorized full-time employment as a live-in caregiver within four years from the date you entered Canada under the Live-in Caregiver Program.
Employer(s) identification
Reminder: the employer(s) must complete this form.
Write your last name
(surname) and given name(s).
Indicate the relationship between you (the employer) and the person receiving care. Examples include:
- parent
- grand-parent
- legal guardian
- self
- etc.
Write your full residential address, including your postal code.
Write the following:
- telephone number at home,
- other numbers where you can be reached (cell phone or work), and
- e-mail address (if applicable)
Write the Labour Market Impact Assessment (LMIA) confirmation number
Employee identification
Write the employee’s last name (surname) and given name(s).
Write the employee’s date of birth.
Employer Declaration
Read and sign the employer’s declaration.
- Write the dates the employee worked for you
- Write the total number of authorized full-time hours worked by your caregiver
- Write the total number of authorized overtime hours worked by your caregiver