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Canadian Immigration Assessment Form

Salutation First name Middle name Last name Age Place Of Birth City Of Birth Country Of Birth Your email Phone Citizenship Country of Residence Preferred Location in Canada

Civil/Martial Status

Date of Divorce

Date of Seperation

Spouse’s Age SPOUSE’S HIGHEST LEVEL OF EDUCATION:

SPOUSE’S LEVEL OF FLUENCY IN ENGLISH: SPOUSE’S LEVEL OF FLUENCY IN FRENCH: SPOUSE’S SKILLED AND PAID EMPLOYMENT WITHIN THE LAST 10 YEARS:

Occupation #1 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #2 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #3 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #4 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #5 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #6 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #7 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #8 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #9 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #10 JOB TITLE: FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

HOW MANY CHILDREN DO YOU HAVE UNDER THE AGE OF 22 YEARS? WILL YOUR SPOUSE AND/OR CHILDREN BE ACCOMPANYING YOU, AS APPLICAPLE?

WHAT IS YOUR HIGHEST LEVEL OF COMPLETED EDUCATION?

NUMBER OF POST-SECONDARY EDUCATION/TRAINING PROGRAMS COMPLETED?

Education/Training #1 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM : Duration of Program TO:

Education/Training #2 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #3 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #4 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of program from: Duration of Program To:

Education/Training #5 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Countryand City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #6 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #7 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #8 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #9 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #10 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #11 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM Duration of Program TO

Education/Training #12 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #13 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and Citty of Study Duration of Program FROM: Duration of Program TO:

Education/Training #14 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Education/Training #15 program of Study Field of Study/Area of Training NAME OF EDUCATIONAL INSTITUTION Country and City of Study Duration of Program FROM: Duration of Program TO:

Years of Skilled and Paid Employment Within the Last 10 Years
Occupation #1 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #2 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #3 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #4 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #5 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #6 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #7 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #8 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #9 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #10 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #11 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #12 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #13 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupatio #14 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

Occupation #15 Job Title FULL-TIME (Minimum 30 hours work per week)/PART-TIME (Minimum 15 hours work per week) DURATION OF EMPLOYMENT FROM: DURATION OF EMPLOYMENT TO:

YOUR LEVEL OF FLUENCY IN ENGLISH: YOUR LEVEL OF FLUENCY IN FRENCH: WHAT IS YOUR FIRST LANGUAGE AND SECOND OR THIRD LANGUAGE SPOKEN, AS APPLICABLE: HAVE YOU OR YOUR SPOUSE COMPLETED AN ENGLISH AND/OR FRENCH LANGUAGE PROFICIENCY EXAM:
PLEASE INDICATE WHICH EXAM YOU COMPLETED AND PROVIDE THE RESULTS FOR EACH OF THE FOUR LANGUAGE SKILLS AREAS (Reading, Writing, Listening, and Speaking).

STAY IN CANADA Have you visited Canada before?
What province did you visit? How long did you stay in this province?
CANADA WORKING EXPERIENCE Have you been employed in Canada as a temporary foreign worker?
In what occupation/job? How many years have you worked full-time in this position in Canada? Are you currently employed in Canada?
Job Offer in Canada Do you have an official/written offer of employment from a Canadian employer?
In what occupation/job? Which province? Is job offer related to field that you have studied?

HAVE YOU AND/OR YOUR SPOUSE (and/or children over the age of 18) EVER BEEN DETAINED, IMPRISONED, CONVICTED, SENTENCED, OR CURRENTLY CHARGED WITH ANY CRIME OR OFFENCE IN ANY COUNTRY WITHIN THE LAST 10 YEARS OR SINCE TURNING THE AGE OF 18, AS APPLICABLE? Do you or Any of Your ACCOMPANYING FAMILY MEMBERS HAVE ANY MEDICAL CONDITIONS, SERIOUS DISEASE, AND/OR CHRONIC ILLNESS? (If Yes, please indicate condition(s) and whether recurring expenses apply). HAVE YOU EVER APPLIED AND BEEN REFUSED ENTRY, A VISA OR ASKED TO LEAVE A COUNTRY?
PLEASE INDICATE THE COUNTRY, REASONS POVIDED, AND TYPE OF VISA APPLICATION REFUSED?
DO YOU OR YOUR SPOUSE HAVE ANY FAMILY MEMBERS (parent, sibling, child, niece or nephew that is 22 years+, and/or aunt/uncle) IN CANADA THAT ARE EITHER CANADIAN CITIZENS OR PERMANENT RESIDENTS? HAVE YOU OR YOUR SPOUSE EVER SUBMITTED A PROFILE IN THE FEDERAL EXPRESS ENTRY POOL?
WHEN WAS THE PROFILE WAS SUBMITTED? WHAT WAS/IS THE CRS SCORE RECEIVED? WHAT IS THE MINIMUM LEVEL OF FUNDS AVAILABLE TO YOU OR YOUR SPOUSE FOR SETTLEMENT PURPOSES IN CANADA (In $CAD):

PLEASE PROVIDE ANY ADDITIONAL COMMENTS/DETAILS YOU BELIEVE TO BE RELEVANT.

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