Personal information First Name: Last Name: E-mail: Phone: Age: Country of residence: ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Marital status: SingleMarriedWidowedCommon-Law Do you have dependent children and if yes how many?: Nationality: ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Do you have a passport? YesNo Expiration date Nationality: ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Do you have a passport? YesNo Expiration date Nationality: ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Do you have a passport? YesNo Expiration date Knowledge of Canadian Official Languages Have you taken the English language exam in the last 2 years? YesNo What language exam did you take? IELTS GeneralCELPIP-G What score did you get? Listening ---4.04.55.05.56.06.57.07.58.08.59.0 Reading ---4.04.55.05.56.06.57.07.58.08.59.0 Writing ---4.04.55.05.56.06.57.07.58.08.59.0 Speaking ---4.04.55.05.56.06.57.07.58.08.59.0 What score did you get? Listening ---less than 55678910-12 Reading ---less than 55678910-12 Writing ---less than 55678910-12 Speaking ---less than 55678910-12 Have you taken the French language exam in the last 2 years? YesNo What language exam did you take? TEF CanadaTCF Canada What score did you get? Listening ---145-180181-216217-248249-279280-297298+ Reading ---121-150151-180181-206207-232233-247248+ Writing ---349-370310-348271-309226-270181-225371+ Speaking ---181-225226-270271-309310-348349-370371+ What score did you get? Listening ---331-368369-397398-457458-502503-522523-548549-699 Reading ---342-374375-405406-452453-498499-523524-548549-699 Writing ---4-567-910-1112-1314-1516-20 Speaking ---4-567-910-1112-1314-1516-20 What is your level of English? Listening ---None at allElementaryIntermediateAdvancedProficiency Reading ---None at allElementaryIntermediateAdvancedProficiency Writing ---None at allElementaryIntermediateAdvancedProficiency Speaking ---None at allElementaryIntermediateAdvancedProficiency What is your level of French? Listening ---None at allElementaryIntermediateAdvancedProficiency Reading ---None at allElementaryIntermediateAdvancedProficiency Writing ---None at allElementaryIntermediateAdvancedProficiency Speaking ---None at allElementaryIntermediateAdvancedProficiency Education What is your level of education? (List all your education history) Did you get this education in Canada? Junior High SchoolHigh SchoolOne-year Post-secondary ProgramTwo-years Post-secondary ProgramBachelor's DegreeMaster's DegreePh.D. YesNo -+ Work experience What is your profession / primary occupation? How many years of skilled work experience do you have? How many years?None1 year2 years3 years or more -+ Do you have Canadian Work Experience YesNo What is your profession / primary occupation? How many years of Canadian work experience do you have? ---None1 year2 years3 years4 years5 years or more -+ Have you received a written job offer from a Canadian employer? YesNo Occupation Province ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukonNunavutNorthwest Territories Duration of your contract ---Less Than 6 Months6 months1 year or longer How many hours per week you will work? Is your job offer supported by a Labour Market Impact Assessment (LMIA)? YesNo Other Personal Information Family in Canada Do you or your spouse/common-law partner have any family members or relatives (parents and siblings only) living in Canada? YesNo Your personal Net Worth Choose currency Canadian DollarsUS DollarsEuro Amount 10.000-15.00015.000-20.00020.000-25.00025.000-50.00050.000-100.000100.000-250.000250.000-500.000 Spouse/Common-law Partner Information What is the highest level of education of your Spouse/Common-Law Partner? ---Junior High SchoolHigh SchoolOne-year Post-secondary ProgramTwo-years Post-secondary ProgramBachelor's DegreeMaster's DegreePh.D. How many years of CANADIAN work experience does your Spouse/Common-Law Partner have within the last ten years? ---None1 year2 years3 years4 years5 years or more Have your spouse taken the English language exam in the last 2 years? YesNo What language exam did he/she take? IELTS GeneralCELPIP-G What score did he/she get? Listening ---4.04.55.05.56.06.57.07.58.08.59.0 Reading ---4.04.55.05.56.06.57.07.58.08.59.0 Writing ---4.04.55.05.56.06.57.07.58.08.59.0 Speaking ---4.04.55.05.56.06.57.07.58.08.59.0 What score did he/she get? Listening ---less than 55678910-12 Reading ---less than 55678910-12 Writing ---less than 55678910-12 Speaking ---less than 55678910-12 Have your spouse taken the French language exam in the last 2 years? YesNo What language exam did he/she take? TEF CanadaTCF Canada What score did he/she get? Listening ---145-180181-216217-248249-279280-297298+ Reading ---121-150151-180181-206207-232233-247248+ Writing ---349-370310-348271-309226-270181-225371+ Speaking ---181-225226-270271-309310-348349-370371+ What score did he/she get? Listening ---331-368369-397398-457458-502503-522523-548549-699 Reading ---342-374375-405406-452453-498499-523524-548549-699 Writing ---4-567-910-1112-1314-1516-20 Speaking ---4-567-910-1112-1314-1516-20 What is your spouse's level of English? Listening ---None at allElementaryIntermediateAdvancedProficiency Reading ---None at allElementaryIntermediateAdvancedProficiency Writing ---None at allElementaryIntermediateAdvancedProficiency Speaking ---None at allElementaryIntermediateAdvancedProficiency What is your spouse's level of French? Listening ---None at allElementaryIntermediateAdvancedProficiency Reading ---None at allElementaryIntermediateAdvancedProficiency Writing ---None at allElementaryIntermediateAdvancedProficiency Speaking ---None at allElementaryIntermediateAdvancedProficiency Additional information Please provide any additional information that you think would be relevant to your immigration assessment. Your ReferralNoneDeyanira SanchezPatricia MoncadaGuadalupe ManzoHarumi TakahashiVíctor FaucheretSandra Duran At what stage of decision making are you? ---Ready to start my applicationJust gathering information When do you plan to start your application? ---ImmediatelyIn the next 3 monthsIn 6-12 monthsI'm not planning yet What is the best way to approach you? EmailSkypeWhatsAppPhone call
