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Preliminary Assessment Form
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Contact Us
Preliminary Assessment Form
Preliminary Assessment Form
PERSONAL INFORMATION
Your Name (given Name)
*
You Last Name (Surname)
*
Date of Birth (DDMMYYYY)
*
Country of Birth
*
Country of Residence
*
Passport number (+country of issue)
*
Passport expiration
*
Current address:
Street Name
*
Province
*
City
*
Postal Code
*
Country
*
Cell phone (including area code)
*
Home Phone (including area code)
Email Address
*
Marital Status
*
If you are married, date married
If you live with your spouse, but are not married, the day you started living together
If you are married or common-law, will your spouse immigrate to Canada with you?
Yes
No
Do you have children?
*
Yes
No
How many children do you have? What are their ages?
TRAVEL TO CANADA
Have you worked in, studied in, or visited Canada?
*
Yes
No
Have you ever had a work or study permit to Canada?
*
Yes
No
If you lived in Canada before what were the dates?
List the total amount of funds you have that are legal and transferrable (do NOT include equity in Real Estate)
Do you or your partner have close family members who are Permanent Residents or Citizens of Canada?
*
Yes
No
ENGLISH LANGUAGE TEST
Have you taken an IELTS or CELPIP English language test?
*
Yes
No
Dates of Test
General or Academic?
Reading Score
Writing Score
Speaking Score
Listening Score
EDUCATION
From:
Name of School
Type of Degree awarded
To:
City and Country
Area of Study
EMPLOYMENT HISTORY
From:
Job Title
Name of Employer (indicate if self-employed)
To:
City and Country
Work in Canada?
Yes
No
TRAVEL FOR THE LAST 10 YEARS
DO NOT INCLUDE TRIPS IN OR TO YOUR COUNTRY OF ORIGIN
From:
City and Country
Visa Issued?
Yes
No
To:
Purpose of Trip
From:
City and Country
Visa Issued?
Yes
No
To:
Purpose of Trip
From:
City and Country
Visa Issued?
Yes
No
To:
Purpose of Trip
ADDITIONAL QUESTIONS
Have you or your spouse ever been convicted of or currently subject to any criminal proceeding in any country?
*
Yes
No
Been refused admission to Canada OR any other country?
Yes
No
Previously sought refugee status in Canada or elsewhere?
*
Yes
No
Had a serious disease or mental disorder?
*
Yes
No
WHAT PERMITS HAVE YOU PREVIOUSLY HELD?
Type of Permit
Issue Date
Expiry Date
Type of Permit
Issue Date
Expiry Date
Type of Permit
Issue Date
Expiry Date
Submit
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