Your contact information:
Your Surname (family name):
Your First Name:
Sex:
--------Select--------
Male
Female
Your Place, Country and Date of Birth (d/m/yr):
Your Phone Number:
Your Email Address:
Your Current Address:
Your Citizenship:
Your Country of Residence:
Your Present Marital status:
--------Select--------
Single
Never Married
Married
Seperated
Divorced
Widowed
Living Commonlaw
As per Canadian Immigration Regulations, the term "Common- law partner" means, in relation to a person, an individual who is cohabiting with the person in a conjugal relationship, having so cohabited for a period of at least one year.
Do You have Children?
--------Select--------
Yes
No
If yes, How many children are under the age of 22 Years?
--------Select--------
None
1
2
3
4
5
How many children are over the age of 22 years?
--------Select--------
None
1
2
3
4
5
If over the age of 22, How many (if any) children are physically or mentally disable and dependent on you?
--------Select--------
None
1
2
If over the age of 22 Years, How many are Enrolled and Attending a Full time course of study?
--------Select--------
None
1
2
3
4
5
Your Educational Background :
Total Number of years of formal Education successfully completed (from primary/elementary school to the present).
Highest level of Education you have successfully completed.
---------------Select one---------------
None
High school diploma
Post secondar one year diploma
Post secondary two year diploma
Post secondary three year diploma
University one year diploma
University two year diploma
University three year diploma
University four year Bachelor's degree
Two University diplomas at the Bachelor level
Master degree
Ph.D
Other diploma or degree
Have you successfully completed a formal apprenticeship/training:
----------Select----------
Yes
No
If yes, please indicate the name and duration of Apprenticeship/Training:
Your English Language proficiency:
Speak
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Read:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Listen:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Write:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Your French Language proficiency:
Speak:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Read:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Listen:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Write:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Have you given one of the following English or French or both proficiency tests?
If yes, When, where and which test have you taken?
What was your overall score?
Your Work Experience for the past 10 Years:
What is your present occupation?
What is your profession?
Please list the jobs held and years of experience.
I f you are married or are in a common-law partnership, please fill in the following information otherwise please skipp this section.
Your Spouse/partner's First Name:
Your Spouse/partner's Last name:
Your Spouse/partner's Date and Place of Birth (d/m/yr).
Will your Spouse/partner accompany you to Canada?
--------Select--------
Yes
No
Highest level of Education your Spouse/partner has successfully completed:
---------------Select one---------------
None
High school diploma
Post secondar one year diploma
Post secondary two year diploma
Post secondary three year diploma
University one year diploma
University two year diploma
University three year diploma
University four year Bachelor's degree
Two University diplomas at the Bachelor level
Master degree
Ph.D
Other diploma or degree
What is your Spouse's/partner's present profession?
Please indicate your Spouse/partner's years and field of Work Experience in the past 10 years:
Your Spouse/partner's English Language proficiency:
Speak
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Read:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Listen:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Write:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Your Spouse/partner's French Language proficiency:
Speak:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Read:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Listen:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Write:
-----Select-----
High proficiency
Moderate proficiency
Basic proficiency
No proficiency
Have your spouse/partner given one of the following English or French or both proficiency tests?
If yes, When, where and which test your spouse/partner has taken?
What was the overall score?
Other Information:
Do you or your spouse have a Service Canada job offer by a Canadian employer for an indeterminate period of time.
Have you or your Spouse/partner have worked Full time in Canada under a work/study permit for a period of one or more years?
If yes, please indicate years of work in Canada.
Have you or your spouse/partner completed a program of full-time study of at least two years’ duration at a post-secondary institution in Canada under a Study permit?
Do you or your Spouse/partner have relatives living in Canada, who are Canadian citizens or Permanent residents of Canada?
-----Select-----
None
Spouse/common-law partner
Parents
Grandparents
Children
Nephew or niece
Brother/sister
Uncle/aunt
If yes, Which province do they live in?
--------Select--------
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Have you ever been refused a Canadian visa?
Have you ever been refused to enter or ordered to leave Canada?
Do you or any family member (if accompanying with you ) have serious health problems?
Have you ever visited Canada?
If yes, when and where did you visit and what was your duration of stay?
Have you or any dependent member of your family ever been charged or convicted of any offence or crime in any country?
If yes, Please indicate who,when, where and the nature of the crime or offence.
Do you have sufficient funds available to support yourself and your family after arrival in Canada as required by the Regulations?. Please note that you are not required to show the availability of funds, if you have an arranged employment. After reviewing you case, we will let you know the amount of money you are required to bring with you.
-----Select-----
Yes
No
Not required/Arranged employment
This Questionnaire contains specific questions and may have missed some questions specific to your case. If you have concerns and questions not listed above, please provide us additional information. If you want to discuss your case in person or by phone please go to the contact us page and fill up the contact us form.
Please describe above in detail about your circumstances for us to understand your concerns and give you the right advice. Your information will be kept strictly in confidence.
Please tell us how you came to know about us
-----Select-----
Yahoo
Google
Other internet sources