Immigration to Canada - Free Assessment Form

Free Assessment

PERSONAL INFORMATION

First Name:
Last Name:
Are you a Citizen of one of the following countries
What is your present Citizenship if not answered above?
Sex:	Male Female
Your Date of Birth (Day/Month/Year):
Are you Married:
Children: (do you have children?)	Yes No
How many children do you have under the age of 22 years?
Do you have Relatives (brothers, or sisters, or parents) living in Canada.	Yes No
What is the highest level of education you have obtained?
Do you have a Criminal Record?	Yes No
Select from the following:	Write English Speak English Read English
Select as many that you can do:	Write French Speak French Read French

Work Experience

List all your work experience	I have worked
Do you have a Profession?	Yes No
If you have a Profession what is it?
Do you own a Business?	Yes No
Do you have Management Experience?	Yes No
How long have you been working at your present job?
Do you have a Job offer here in Canada?	Yes No

Contact Information

Current Address:
City:
State/Province:
Country:
Postal Code/Zip Code:

Contact:
Phone - Home:
Phone - Work:
Fax:
Email:

If you have a Criminal Record or certain Health Problems you may be denied Immigration Status to Canada. We will review your information and respond as soon as possible.

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