Free assessment immigration Vancouver Canada

1. Personal details


Last name or surname:
First name:
Date of birth:	Day Month Year
Citizen of:
List countries in which you resided more than 6 months:	1. 2. 3.
Current address:
E-mail:
Telephone / fax (including area code):

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2. Marital status

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Are you married or have you been living with your common-law partner?	Yes No If yes, since:
Are going to get married?	Yes No If yes, when:

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3. Information about children

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Please list all children regardless of their age and whether or not they will immigrate with you to Canada.
Indicate if you have children: Yes No

	Son/Daugther	Date of Birth
1.	Please choose	Day Month Year
2.	Please choose	Day Month Year
3.	Please choose	Day Month Year
4.	Please choose	Day Month Year
5.	Please choose	Day Month Year

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4. Education

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Please provide detailed information about your education. List all the dates, educational institutions (including high school), field of study, diploma or degree, full-time/part-time.

	Number of years (month / year)	Name of educational institution (Country, city)	Field of study, full/part-time	Degree/diploma
1.	From / To /
2.	From / To /
3.	From / To /

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5. Language proficiency

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Level of language proficiency: advanced, medium, basic, none. Even if you have basic language ability, please complete the questionnaire. You may still qualify.

	English	French
Reading	Please choose	Please choose
Writing	Please choose	Please choose
Speaking	Please choose	Please choose
Listening	Please choose	Please choose

If you claim advanced or medium language proficiency, please explain in detail when and where you learned English or French (e.g. language courses, studying or working in the language environment, results of language tests, etc.):

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6. Experience

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Please note: CIC will only consider work experience in the past 10 years. Please start with your present/last job. If you worked part-time, indicate the number of hours/week.

	(Month / year)	Name of company/organization and it`s location.	Job title/position
1.	From / To /
2.	From / To /
3.	From / To /

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7. Additional questions

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Do you or your family have any relatives in Canada?	Yes No
If yes, who are your relatives and what province do they live in?
Do you have an offer of employment from a Canadian employer?	Yes No
Have you or your spouse studied in Canada?	Yes No
Have your family members ever had any serious disease or physical or mental disorder?	Yes No
Have you or your family members ever been convicated of or are currently charged with any crime of offence in any country?	Yes No
Have you or spouse been ordered to leave Canada?	Yes No
Have you or your family members ever applied for temporary status in Canada (visitor/student/worker)?	Yes No
Have you or your spouse ever applied for permanent status in Canada?	Yes No

If you answered "Yes" to any of the questions above, please explain:

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Online Assessment

Information about the Applicant.

Information about the Spouse.

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