PERSONAL DETAILS

Title

Family or Surname *

Name *

First

Last

Gender *

Date of Birth *

Place of Birth *

Citizenship *

Passport No. *

Date of Issue *

Expiry Date *

Country of last permanent residence/Since the year *

Marital status/ Date of Marriage *

Residential Address/Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone/Fax-Number *

Email *

PERSONAL DETAILS OF FAMILY MEMBERS

Title *

Family or Surname *

Name *

First

Last

Relation *

Date of Birth of Family Members *

Country of Birth *

Citizenship *

Passport Number *

Date of Issue *

Expiry Date *

Country of last permanent residence/Since the year *

EDUCATIONAL BACKGROUD

Years of Schooling, including College/University *

Years of Schooling, including College/University

Highest Level of Education Obtained *

Highest Level of Education Obtained

Any type of apprenticeship? If so, where and for whom? *

Any type of apprenticeship? If so, where and for whom?

If you have completed university/college, please answer the questions below. Otherwise, move to “Employment background”

Name of previous university/college, program of study, highest level completed, and dates attended (1)

Name of previous university/college, program of study, highest level completed, and dates attended (1) (copy)

Name of previous university/college, program of study, highest level completed, and dates attended (2)

Name of previous university/college, program of study, highest level completed, and dates attended (2) (copy)

Name of previous university/college, program of study, highest level completed, and dates attended (3)

EMPLOYMENT BACKGROUD

Your most recent/current employer, city and country, type of work performed, your official title/position, and dates from and to *

Your previous employer, city and country, type of work performed, your official title/position, and dates from and to (1) *

Your previous employer, city and country, type of work performed, your official title/position, and dates from and to (2) *

Your previous employer, city and country, type of work performed, your official title/position, and dates from and to (3) *

What other type of work are you qualified to perform? *

What type of work does your spouse do, (if applicable)? What is the highest level of education obtained by her (name of educational institution, type of diploma or certificate)?

LANGUAGE ABILITY

Please select your language abilities for each skill

ENGLISH

IELTS Score (You) *

IELTS Score (Your Spouse)

Listening skills (You) *

Listening skills (Your Spouse)

Speaking skills (You) *

Speaking skills (Your Spouse)

Reading skills (You) *

Reading skills (Your Spouse)

Writing skills (You) *

Writing skills (Your Spouse)

French

Listening skills (You) *

Listening skills (Your Spouse)

Writing skills (You) *

Writing skills (Your Spouse)

Speaking skills (You) *

Speaking skills (Your Spouse)

Reading skills (You) *

Reading skills (Your Spouse)

FAMILY IN CANADA

Please check if you have any direct relatives in Canada - parents, children, brothers/sisters, grandparents, aunts/uncles

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Relationship to you

Sponsor Name

First

Last

Sponsor Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Sponsor Relationship to you

If you have parents/children or spouse in Canada, are they willing to sponsor you?

FINANCIAL INFORMATION

Please provide the following information in U.S. dollars

How much money do you have in your bank account? *

What is the value of your property? *

What is the value of your stocks/bonds?

What is the amount of other assets that you have? *

What is your total net worth (your assets minus your debts)? *

GENERAL QUESTIONS

Have you or your accompanying dependents ever

Had any serious disease or physical or mental disorder? *

Yes
No

Been convicted of or are currently charged with any crime or offence in any country? *

Yes
No

Applied previously for an immigrant or temporary resident visa to Canada (i.e. visitor/student/worker)? *

Yes
No

Been refused an immigrant or visitor visa to Canada or any other country? *

Yes
No

Been refused admission to, or ordered to leave Canada or any other country? *

Yes
No

Been involved in the commission of a war crime or a crime against humanity? *

Yes
No

Applied previously for permanent status in Canada? *

Yes
No

Free Assessment Form

PERSONAL DETAILS

PERSONAL DETAILS OF FAMILY MEMBERS

EDUCATIONAL BACKGROUD

EMPLOYMENT BACKGROUD

LANGUAGE ABILITY

ENGLISH

French

FAMILY IN CANADA

FINANCIAL INFORMATION

GENERAL QUESTIONS