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Eligibility Form
Website Eligibility Assessment Form
General Information
First Name:
Last Name:
Address:
State/Province:
Country
Postal/Zip Code:
Home Phone:
Work Phone:
Fax Number:
E-mail Address:
Sex:
Marital Status:
Male
Female
Single
Married
Ages of your children:
Your Information
Date of Birth:(dd/mm/yy)
Highest level of education successfully completed
Total years of education:
Primary
Secondary
Post Secondary
Please list your employment/business experience in the last 10 years:
Occupation:
Number of years of experience:
Proficiency in English:
Fluent
Well
With Difficulty
None
Proficiency in French:
Fluent
Well
With Difficulty
None
Spouse's Information
Date of Birth:(dd/mm/yy)
Highest level of education successfully completed
Total years of education:
Primary
Secondary
Post Secondary
Please list spouse's employment/business experience in the last 10 years:
Occupation:
Number of years of experience:
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?
Yes
No
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?
Yes
No
If so provide details:
Have you, your spouse or children been charged or convicted of any offence?
Yes
No
If so provide details:
Have you, your spouse worked in Canada?
Yes
No
If so provide details:
Have you, your spouse attended in school in Canada?
Yes
No
If so provide details:
Estimate of your and your spouse's total net assets.
If necessary would you be able to obtain a job offer in Canada?
Yes
No
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