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If you would like to have your circumstances assessed as to whether you are eligible for immigration to Canada, please complete and send us the following information. There will be no charge for this assessment.
GENERAL INFORMATION
First Name
Last Name
Address
State/Province
Country
Postal/Zip Code
Home Phone
Work Phone
Fax Number
Email Address
Marital Status
Single
Married
Sex
Male
Female
Ages of your children
YOUR INFORMATION
Date of Birth
Total Years of Primary Education
Total Years of Secondary Education
Total Years of Post Secondary Education
Highest level of education successfully completed
Please list your employment/business experience in the last 10 years, including the number of years at each occupation:
Proficiency in English
Fluent
Well
With Difficulty
None
Proficiency in French
Fluent
Well
With Difficulty
None
SPOUSE'S INFORMATION
Date of birth
Total Years of Primary Education
Total Years of Secondary Education
Total Years of Post secondary Education
Highest level of education successfully completed
Please list your spouse's employment/business experience in the last 10 years, including the number of years at each occupation:
Proficiency in English:
Fluent
Well
With Difficulty
None
Proficiency in French:
Fluent
Well
With Difficulty
None
OTHER
Do you or your spouse have any blood relatives in Canada?
No
Yes
If so, what is their relationship to you or your spouse?
Have you, your spouse or children suffered from any serious disease or physical or mental disorder?
No
Yes
If so, provide details:
Have you, your spouse or children been charged or convicted of any offence?
No
Yes
If so, provide details:
Have you or your spouse worked in Canada?
No
Yes
If so, provide details:
Have you or your spouse attended school in Canada?
No
Yes
If so, provide details:
Estimate of you and your spouse's total net assets.
Would you be able to obtain a job offer in Canada?
No
Yes
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