Atlantic Immigration Program - Employer Designation Application

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Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c.F-15-01 as it relates directly to and is necessary for the administration of the Atlantic Immigration Program. If you have any questions about this collection of personal information, you may contact the Office of Immigration by phone at 902-620-3628. Information may be verified.

Identification

Enter the name of the primary authorized signing officer and the physical location of the business in the fields below.

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address

Position Within Business

Operating Business Name

Enter the name the business is operating under if different than above.

Is the mailing address of the business the same as the address entered above?

Mailing Address

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Secondary Authorized Signing Officer

Does your business have a secondary authorized signing officer?

First Name

Last Name

Position Within Business

Telephone Number

For example 902-555-5555

Email Address