Please complete this free assessment form for
evaluation of your case.

Your Full Name:

Email Address:

Telephone with area code:


Fax Number :


Country of Residence:


Date of Birth:
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: January February March April May June July August September October November December Year:

Your highest level of Education
High School Diploma College Diploma, 2years College Diploma, 3years Bachelor's Degree Master's Degree ph.D Medical Doctor(M.D.) Others Not Copmleted

Occupation:


Experience:


Sex :
Male Female

Marital Status:
Married Single Seperated Divorced Widowed Common Low

Full name of your spouse(wife/husband):

Spouse's (wife/husband) highest level of Education 
No Spouse High School Diploma College Diploma, 2years College Diploma, 3years Bachelor's Degree Master's Degree ph.D Medical Doctor(M.D.) Others Not Completed

Number of chlidren: Their ages:

Relatives in Canada and your relationship with them: Not Relataives in Canada Mother or Father Brother or Sister Grandmother or Grandfather Aunt or Uncle Niece or Nephew(19 years old or older) Spouse or Fiances(e) Daughter or Son

Your language skills in English:  

Reading: Very good Average Basic Not at all Writing: Very good Average Basic Not at all Speaking: Very good Average Basic Not at all Listening: Very good Average Basic Not at all

Your language skills in French:

Reading: Very good Average Basic Not at all Writing: Very good Average Basic Not at all Speaking: Very good Average Basic Not at all Listening: Very good Average Basic Not at all

If non of the above applies, please explain:

Describe your work experience including number of years and your daily duties:


Do you have an offer of employment from a Canadian employer? Yes No

If yes, describe your job offer including the employer's name:


Are you able to invest in Canada? No Yes

Are you interested to obtain a student visa? No Yes

Have you ever worked in Canada? No Yes

Have you ever studied in Canada? No Yes

Have you ever applied for a Canadian Visa? No Yes

Has your request for a Canadian Visa ever been rejected? No Yes

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