Free Assessment Form 



In order that we may assess your status realistically
please complete all sections in the following questionnaire
It may take 15 minutes or more

Personal Information
Name:
Email Address:
Please ensure that you have sufficient space in your e-mail account to receive a reply.
Nationality:
Current Place of Residence: (City,Country)
Daytime Telephone number preceded by the area code: (areacode , phone number)
Home, Office, or Mobile
Date of Birth:  
 Day        Month             Year
Sex: Male Female
Marital Status : Single

Married

Divorced/Separated
Married applicants: Please provide details
Spouse's Date of Birth:  
 Day        Month             Year
Spouse's Level of Education and duration:                                       (If other please specify)
Spouse's total years of education:
(Starting from primary school)

Spouse's field of study:


Spouse's Number of Years and Months of Working Experience:

Language Ability in French:
Number of Dependant Children:

Your language ability in English and French
English
Read
Write
Speak
Listen
French
Read
Write
Speak
Listen

Your Educational Profile
Total Years of education:
(Including Primary, Secondary, and Post Secondary)
1. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
2. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
3. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

Your Employment History
Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Number of Hours Worked per Week: Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties:

(please provide details)
City:
Country:
Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Number of Hours Worked per Week: Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties:

(please provide details)
City:
Country:
Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Number of Hours Worked per Week: Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties:

(please provide details)
City:
Country:

If you have additional experience, please include in additional comments below.
Other
Relationship to Closest Blood Relative in Canada (Canadian Citizen or Landed Immigrant):
Blood Parent Blood Aunt/Uncle Blood Brother or Sister Blood Son/Daughter

Blood Niece/Nephew (22 years or older) Blood Grand Parent Blood Cousin
Relative Province of Residence :

Personal Net worth (CAD$):

Do you currently have an offer of
employment from a Canadian employer? 		Yes No
If your answer to the above question is "Yes" provide details here:


Have you, your spouse or common-law partner ever:
  • Had any serious disease
Yes No
  • Been convicted of or currently charged with any crime or offence in any country
Yes No
  • Applied previously for an immigrant visa to Canada
Yes No
  • Visited Canada (visit,study,work)
Yes No
Are you able to obtain a visitors visa to Canada Yes No
If answer to any of above is "Yes" provide details here:


Please tell us how you were introduced to this site:
Search Engine (please specify name & keywords used for the search)
Newspaper or Magazine (please specify)
Newsgroup (please specify)
General Recommendation

Additional Comments if Any: