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Free Skilled Assessment Questionnaire for Canadian Immigration

Please mention [Yes] where ever applicable in the brackets [ ] provided

|CLIENT ASSESSMENT FORM |

|Principal Applicant |

|Last Name: |First Name: |Middle Name: |

| |House No: |Street: |City: |

|Mailing Address | | | |

| | | | |

| |State: |Country: |Postal Code: |

| | | | |

|Telephone |Home: |Business: |

| |Fax: |Mobile: |

| |Email: | |

|Date of Birth |Day: |Month: |Year: |Sex: |

|Place of Birth |City: |State: |Country: |

|Citizenship: | |

|Passport |Passport Number: |Passport Issued on: |Passport will Expire on: |

| | | | |

|Marital Status: Mention [Yes] |Never Married |Engaged [ ] |Married [ ] |

|where applicable: |[ ] | | |

| |Widowed [ ] |Separated [ ] |Divorced [ ] |

| |Spouse Information |

|Spouse Info: |If you are married or engaged please provide details of spouse |

|Full Name: | |

|Date of Birth |Day: |Month: |Year: |Sex: |

|Place of Birth |City: |State: |Country: |

|Citizenship: | |

|Passport |Passport Number: |Passport Issued on: |Passport will Expire on: |

| | | | |

|Occupation: | |

|Experience: | |

|Marriage Date |Day: |Month: |Year: |Place: |

| | |

|Education - Spouse |

|Highest Completed |University Degree |Non University Diploma |

|Primary School [ ] |1 year University credential [ ] |One year [ ] |

|High School |2 year University credential [ ] |Two year [ ] |

|[ ] | | |

| |3 year University credential [ ] |Three year [ ] |

| |Bachelor’s degree [ ] | |

| |Masters & PhD [ ] | |

|Years of Education |How many years of Education has spouse completed: | [______Years] |

| |Family Information |

|Children |Full Name: |Date of Birth: |Son: |Daughter: |

| | | |[ ] |[ ] |

| | | |[ ] |[ ] |

| | | |[ ] |[ ] |

| | Total number of Children below 22 years of Age: [_____] |

| |Total number of Children above 22 years of Age: [_____] |

| | |

| |Relatives In Canada |

|Do you/your spouse have relatives living in Canada?:Mention Yes/No: | [ ] |

|Name: |Relationship: |Status in Canada: |

| | | |

| | | |

| |Principal Applicant Education |

|Education Info | |

|Period |Name & Address of |Courses: | % |Degree /Diploma/ Certificate |

| |Institutions; | | |Issued: |

|From: |To: | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

|Total Years of Education successfully completed | [_______Years] |

| | |

| |Principal Applicant Employment |

|Work History | |

|Date |Name & Address of Employer: |City & Country: |Job Designation: |

|From: |To: | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

|Detailed Responsibilities & |List duties & responsibilities of each position at previous employment since last 10 years: |

|Duties: | |

|Trade or Profession |Current Occupation: |NOC Number: |

| | | |

|Job Description |Please attach a separate sheet giving a detailed description of the job responsibilities performed |

| |by you on a day to day basis: |

|Total Work Experience |How many years of work experience do you have in the last 10 years? Mention [Yes] where applicable: |

| |0 [ ] |

| |1 [ ] |

| |2 [ ] |

| |3 [ ] |

| |4 & Up [ ] |

| | |

|Intended Job In Canada: | |

| |LANGUAGES |

|Language Ability |Please indicate your ability to communicate in English and French by checking the appropriate column|

| |Mention [Yes] where applicable: |

|English |Speak |Read |Write |Understand |

| |[ ] |[ ] |[ ] |[ ] |

| | |

|French |Speak |Read |Write |Understand |

| |[ ] |[ ] |[ ] |[ ] |

| | |

|Language Test |Have you or could you pass a formal English/French Language Test? Mention Yes / No: |

| |English: |[ ] |French: |[ ] |

| | |

| |Language Test Results |

|ENGLISH |IELTS | | | |

|Overall Score |Listening |Reading |Writing |Speaking |

| | | | | |

| | | | | |

|FRENCH | | | | |

|Overall Score |Listening |Reading |Writing |Speaking |

| | | | | |

| |OTHER DETAILS |

|Do you hold a work permit for Canada? Mention Yes / No: | [ ] |

|Do you have a Job offer or potential job offer from a Canadian Employer? Mention Yes / No: | [ ] |

|Have you or your spouse, common law partner or same sex partner ever worked in Canada for one full year? | [ ] |

|Mention Yes / No: | |

|Have you or your spouse, common law partner or same sex partner ever studied in Canada for more than two | [ ] |

|years? Mention Yes / No: | |

|Do you or your spouse, common law partner or same sex partner have a valid offer of employment in Canada | [ ] |

|upon your arrival? Mention Yes / No: | |

|Do you have a spouse, common law partner or same sex partner who is a Canadian Citizen or Permanent | [ ] |

|Resident? Mention Yes / No: | |

|Do you or your spouse, common law partner or same sex partner have any close family relationships in Canada?| [ ] |

|Mention Yes / No: | |

|If you have answered 'Yes' to any of the above questions, please provide details below: |

| |BUSINESS INFORMATION |

|Business |Have you ever owned and operated your own business? Mention Yes / No: | [ ] |

| |If yes, email a complete business profile of your company to info@ |

|Company Profile |Details of business activities should include: Type of Business, your role, duties and |

| |responsibilities within the business. |

| | |

| |FINANCIAL INFORMATION |

|Do you have the Financial resources to adequately settle yourself in Canada? Mention Yes / No: | [ ] |

|Net Worth |Bank: |

| |Property : |

| |Assets: |

| |Other: |

| |Total: |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| |If others give details here: |

|Transferable Funds / Assets |Cash (in Cdn$): |Property(in Cdn$): |

| | |

| |PRIOR APPLICATION TO CANADA |

|Have you ever visited Canada? Mention Yes / No: | [ ] |

|Who did you visit |Where: |When: |Purpose: |

| | | | |

|Have you ever studied in Canada? Mention Yes / No: | [ ] |

|If yes, give details |Name of Institution: |Course of study: |Date: |

| | | | |

|Have you ever worked in Canada? Mention Yes / No: | [ ] |

|If yes, give details |Name of Employer: |Occupation: |Date: |

| | |

|Have you ever been refused a Visa? Mention Yes / No: | [ ] |

|If yes, provide details below: | |

|Why Canada? |Briefly explain your interest in Immigrating to Canada?: |

| | |

| | |

|Other Notes |Any other information you believe that is relevant to this assessment?: |

| | |

|Why Us? |

| |

| |

|How did you come to know about our Immigration Consultancy firm? Mention [Yes] where applicable: |

|Referral [ ] |Friend [ ] |Seminar [ ] |

|Newspaper [ ] |Internet [ ] |Other [ ] _________ |

| |PASTE RESUME HERE (Optional) |

| |

| |

|In addition to the Assessment form you may send an updated Resume or Curriculum vitae, if available, as an attachment to our email |

|info@ |

|DECLARATION | |

|I agree that the information furnished by me in the above form is true and correct, to the best of my knowledge, and given for the |

|sole purpose of my FREE assessment regarding Immigration to Canada. (YES/NO) |

| |

| |

|Date: |

|Place: |

| |

| |

|All information provided in this form will remain strictly confidential and secure. It will not be shared with any external |

|sources. This information is used for the sole purpose of preliminary assessment of your chances to successfully immigrate to |

|Canada. Please see our Privacy Policy. |

| |

|Thank You! |Information provided to our firm is strictly Private & Confidential. |

| |

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