Questionnaire Personal informationLAST NAME, Given Name(s)*Gender*MaleFemaleDate of birth* Date Format: MM slash DD slash YYYY Marital status*Never marriedMarriedDivorcedWidowedCommon lawLegally seperatedNumber of children and their ages. Telephone number*Email address* Citizenship(s)*Residential address*City and countryEducation(diplomas or certificates earned in secondary and post-secondary education: university, college and apprenticeship training)*Certificate, diploma or degree issuedName of institutionField of studyFrom (month, year)To (month, year)City, country EmploymentYour paid work experience during the last 10 years.*Job title, duties and responsibilitiesNumber of hours worked per weekFrom (month, year)To (month, year)Name of employerCity, country Are there any other details you would like to provide regarding your work experience?English language skillsSpeak*HighModerateBasicNoneListen*HighModerateBasicNoneRead*HighModerateBasicNoneWrite*HighModerateBasicNoneIf you indicated the score, please provide the date you took the test. If you have been tested for language ability under the IELTS, CELPIC or TEF, please record your scores here.Test nameDateSpeakListenReadWrite French language skillsSpeak*HighModerateBasicNoneListen*HighModerateBasicNoneRead*HighModerateBasicNoneWrite*HighModerateBasicNoneIf you indicated the score, please provide the date you took the test. If you have been tested for language ability under the IELTS, CELPIC or TEF, please record your scores here.Test nameDateSpeakListenReadWrite Spouse's InformationLAST NAME, Given Name(s)*GenderMaleFemaleDate of birth Date Format: MM slash DD slash YYYY Spouse's Education(diplomas or certificates earned in secondary and post-secondary education: university, college and apprenticeship training)Certificate, diploma or degree issuedName of institutionField of studyFrom (month, year)To (month, year)City, country Spouse's EmploymentYour spouse's paid work experience during the last 10 years.Job title, duties and responsibilitiesNumber of hours worked per weekFrom (month, year)To (month, year)Name of employerCity, country Spouse's English language skillsSpeakHighModerateBasicNoneListenHighModerateBasicNoneReadHighModerateBasicNoneWriteHighModerateBasicNoneIf you indicated the score, please provide the date you took the test. If you have been tested for language ability under the IELTS, CELPIC or TEF, please record your scores here.Test nameDateSpeakListenReadWrite Spouse's French language skillsSpeakHighModerateBasicNoneListenHighModerateBasicNoneReadHighModerateBasicNoneWriteHighModerateBasicNoneIf you indicated the score, please provide the date you took the test. If you have been tested for language ability under the IELTS, CELPIC or TEF, please record your scores here.Test nameDateSpeakListenReadWrite OtherRelative residing in Canada*Do you or your spouse have a relative residing in Canada who is 18 years or older and who is a permanent resident or Canadian citizen?NoParentGrandparentChildGrandchildBrother/sisterAunt/uncleNiece or nephewThe province or territory your relative resides atAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaOntarioPrince Edward IslandSaskatchewanYukonUnencumbered fundsPlease indicate the amount of unencumbered funds available to bring for settling in Canada, in Canadian dollars?Net worthWhat is your verifiable net worth, including your assets and the assets of your spouse, in Canadian dollars? This question will assist us to establish if you might qualify for immigration under the Business class.AdmissibilityHave you ever been refused any kind of visa, admission, or been ordered to leave Canada?NoYesIf you replied “yes”, please provide details.How did you hear about us?Business directory Other (please specify)Search enginesFacebookOther (please specify)OtherImmigration newsletter Yes, I consent to receive your free Canadian immigration and visa updates. Do you want to receive an email with a copy of the questionnaire?* Yes No
