10211 Yonge Street

Suite 203

Richmond Hill, Ontario, Canada

L4C 3B3

 

Phone: (905) 780-8451 office

          (416) 835-6989 cell

          (905) 780-1829 fax

 

akarb25@hotmail.com
 
 

Canadian Immigration Assessment Form for Independent
(Skilled Workers) Immigration

About You
Title *
First name *
Last name *
Date of birth *
Place of birth *
Gender * Male   Female
Present occupation *
Nominated occupation *
How long have you been working in nominated occupation? *
Annual Income (Can$)
Please see universal currency converter for exchange rate
Present address
Street Address
Town/City
Post Code/Zip Code
Country *
Contact details
Telephone *
Fax
E-mail
Web page
Emigration details
Your plans for emigration *
Do you have family or dependants who will emigrate with you? * Yes No
If "Yes" please give details
Age Relationship to you Occupation
Do you or your spouse/common law partner have relatives or ancestors in Canada?
Age Relationship to you Occupation Nationality Immigration Status
Have you had any type of visa to Canada before? * Yes No
If yes, please give the following details
Type
Date Issued
Place Issued
Length of validity
Have you ever been refused a visa? * Yes No
If yes, please give details
Have you or any of your immediate family members ever been convicted of any crime (however minor the offence)?*
Yes No
If yes, please give details
Have you or any of your immediate family had any serious health problems?* Yes No
If yes, please give details
Why do you wish to emigrate?
Funds
Please see universal currency convertor for exchange rate
How much do you have in the way of funds? (in Can$)
Savings on deposit
Value of other assets
Amount you intend to take with you *
English language ability
Speaking * No With difficulty Well Fluent
Reading * No With difficulty Well Fluent
Writing * No With difficulty Well Fluent
Understanding * No With difficulty Well Fluent
French language ability
Speaking * No With difficulty Well Fluent
Reading * No With difficulty Well Fluent
Writing * No With difficulty Well Fluent
Understanding * No With difficulty Well Fluent
Job offer in Canada
Do you have a job offer * Yes No
If so what is the occupation?
Has the job been approved by Human Resources Development Canada? Yes No
Work Experience
Total years of skilled level experience
1. Work experience
Dates of Employment *
dd/mm/yyyy - dd/mm/yyyy
Employing Company *
Job Title *
Skills used /Responsibilities *
Country *
2. Work experience
Dates of Employment
dd/mm/yyyy - dd/mm/yyyy
Employing Company
Job Title
Skills used /Responsibilities
Country
3. Work experience
Dates of Employment
dd/mm/yyyy - dd/mm/yyyy
Employing Company
Job Title
Skills used /Responsibilities
Country
Qualifications
1. Qualification
Dates of study *
dd/mm/yyyy - dd/mm/yyyy
University/College/School *
Subject *
Qualification *
Country *
2. Qualification
Dates of study
dd/mm/yyyy - dd/mm/yyyy
University/College/School
Subject
Qualification
Country
3. Qualification
Dates of study
dd/mm/yyyy - dd/mm/yyyy
University/College/School
Subject
Qualification
Country
Addresses for 10 past years
1. Address
Dates of residence *
dd/mm/yyyy - dd/mm/yyyy
Street Address *
Town/City *
Post Code/Zip Code *
Country *
2. Address
Dates of residence
dd/mm/yyyy - dd/mm/yyyy
Street Address
Town/City
Post Code/Zip Code
Country
3. Address
Dates of occupation
dd/mm/yyyy - dd/mm/yyyy
Street Address
Town/City
Post Code/Zip Code
Country
Work Experience for your Spouse or Common Law Partner
1. Work experience
Dates of Employment *
dd/mm/yyyy - dd/mm/yyyy
Employing Company *
Job Title *
Skills used /Responsibilities *
Country *
2. Work experience
Dates of Employment
dd/mm/yyyy - dd/mm/yyyy
Employing Company
Job Title
Skills used /Responsibilities
Country
3. Work experience
Dates of Employment
dd/mm/yyyy - dd/mm/yyyy
Employing Company
Job Title
Skills used /Responsibilities
Country
Qualifications for your Spouse or Common Law Partner
1. Qualification
Dates of study
dd/mm/yyyy - dd/mm/yyyy
University/College/School
Subject
Qualification
Country
2. Qualification
Dates of study
dd/mm/yyyy - dd/mm/yyyy
University/College/School
Subject
Qualification
Country
3. Qualification
Dates of study
dd/mm/yyyy - dd/mm/yyyy
University/College/School
Subject
Qualification
Country
Any Additional Information
 

* - required fields