Immigration Assessment Form

PERSONAL INFORMATION
Name
Last Name
Present Address
Contact Phone Number
Email
Facsimile
Date of Birth
Place of Birth
Marital Status
Sex	Male		Female
Country of Citizenship
Other Citizenship or Residence Status
Number of Children
Children's Age(s)
If you or your spouse have following relatives in Canada who are either Canadian citizens or permanent residents who currently reside in Canada, please state their relationship to you or your spouse?
EDUCATION
Please select your highest level of education completed:
Name of institution attended and the name of the diploma or degree granted, if applicable:
Please provide your spouse's highest level of education, if applicable:
WORK EXPERIENCE
Present Occupation: Job Title: Number of years in Position:
Previous Occupation 1: Job Title: Number of years in Position:
Previous Occupation 2: Job Title: Number of years in Position:
Previous Occupation 3: Job Title: Number of years in Position:
Previous Occupation 4: Job Title: Number of years in Position:
LANGUAGE SKILLS
Select your level of proficiency in English:	Speak	Read	Write
Select your level of proficiency in French:	Speak	Read	Write
ADDITIONAL INFORMATION
Funds available for transferring to Canada: (include assets that can be converted into funds)
If you or your spouse have any criminal charges or convictions, please provide details:
If you or your spouse have any physical or mental health medical issues, please provide details:
Additional comments: