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 IslandSaskatchewanYukonEmployer in CanadaDo you have an employer in Canada that has made you a permeant job offer and has obtained a positive Labour Market Impact Assessment from ESDC?NoYesHave you or your spouse completed at least two academic years of full-time study at a secondary or post-secondary school in Canada?*YesNoUnencumbered 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, your spouse or any of your childrenever remained beyond the validity of status, attended school or worked without authorization in Canada?NoYesever been refused any kind of visa, admission, or been ordered to leave Canada?NoYesever committed an offence or been charged with an offence in any country?NoYesever submitted an application for immigration to Canada in the past?NoYeshad any serious disease?NoYesIf you have replied “yes” to any of the above questions, 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. Email to YourselfDo you want to receive an email with a copy of the questionnaire?* Yes No
