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Assessment Form
Assessment Form

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Office :+ 1-604-229-0506
Fax :+ 1-604-594-1044
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Certified members of:
Please complete the following questionaire to receive a free assessment of your qualification for Canadian immigration.
bulletsPersonal Information
Name :
Email Address :
Nationality :
Current Place of Residence :
Telephone Number :
Date of Birth :
Sex :
Male Female
Marital Status :
Single
Married
Divorced/Separated
bulletsSpouse Information
If Married, please provide Spouse’s Characteristics in the fields below:
Spouse’s Date of Birth :
Spouse’s Level of Education and Duration :
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 :
bulletsAbility in English and French
English
Read :
Write :
Speak :
Listen :
French
Read :
Write :
Speak :
Listen :
bulletsEducational Profile
Total years of education : (Including Primary, Secondary, and Post Secondary)
1. Certificate : (if other space specify)
Field of Study :
Date of Started : (Month, Year)
Date of Graduation : (Month, Year)
Name of Institution :
City :
Country :
2. Certificate : (if other space specify)
Field of Study :
Date of Started : (Month, Year)
Date of Graduation : (Month, Year)
Name of Institution :
City :
Country :
3. Certificate : (if other space specify)
Field of Study :
Date of Started : (Month, Year)
Date of Graduation : (Month, Year)
Name of Institution :
City :
Country :
bulletsEmployment History
1. 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 :
2. 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 :
3. 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 the Additional Comments below.
bulletsOther
• 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 or spouse/common law partner or dependent children 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 :