Personal information First Name: Last Name: E-mail: Phone: Age: Country of residence: —Please choose an option—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: —Please choose an option—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: —Please choose an option—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: —Please choose an option—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 —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 Reading —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 Writing —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 Speaking —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 What score did you get? Listening —Please choose an option—less than 55678910-12 Reading —Please choose an option—less than 55678910-12 Writing —Please choose an option—less than 55678910-12 Speaking —Please choose an option—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 —Please choose an option—145-180181-216217-248249-279280-297298+ Reading —Please choose an option—121-150151-180181-206207-232233-247248+ Writing —Please choose an option—349-370310-348271-309226-270181-225371+ Speaking —Please choose an option—181-225226-270271-309310-348349-370371+ What score did you get? Listening —Please choose an option—331-368369-397398-457458-502503-522523-548549-699 Reading —Please choose an option—342-374375-405406-452453-498499-523524-548549-699 Writing —Please choose an option—4-567-910-1112-1314-1516-20 Speaking —Please choose an option—4-567-910-1112-1314-1516-20 What is your level of English? Listening —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Reading —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Writing —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Speaking —Please choose an option—None at allElementaryIntermediateAdvancedProficiency What is your level of French? Listening —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Reading —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Writing —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Speaking —Please choose an option—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 ExperienceYesNo What is your profession / primary occupation? How many years of Canadian work experience do you have? —Please choose an option—None1 year2 years3 years4 years5 years or more -+ Have you received a written job offer from a Canadian employer? YesNo Occupation Province —Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukonNunavutNorthwest Territories Duration of your contract —Please choose an option—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? —Please choose an option—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? —Please choose an option—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 —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 Reading —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 Writing —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 Speaking —Please choose an option—4.04.55.05.56.06.57.07.58.08.59.0 What score did he/she get? Listening —Please choose an option—less than 55678910-12 Reading —Please choose an option—less than 55678910-12 Writing —Please choose an option—less than 55678910-12 Speaking —Please choose an option—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 —Please choose an option—145-180181-216217-248249-279280-297298+ Reading —Please choose an option—121-150151-180181-206207-232233-247248+ Writing —Please choose an option—349-370310-348271-309226-270181-225371+ Speaking —Please choose an option—181-225226-270271-309310-348349-370371+ What score did he/she get? Listening —Please choose an option—331-368369-397398-457458-502503-522523-548549-699 Reading —Please choose an option—342-374375-405406-452453-498499-523524-548549-699 Writing —Please choose an option—4-567-910-1112-1314-1516-20 Speaking —Please choose an option—4-567-910-1112-1314-1516-20 What is your spouse's level of English? Listening —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Reading —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Writing —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Speaking —Please choose an option—None at allElementaryIntermediateAdvancedProficiency What is your spouse's level of French? Listening —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Reading —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Writing —Please choose an option—None at allElementaryIntermediateAdvancedProficiency Speaking —Please choose an option—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? —Please choose an option—Ready to start my applicationJust gathering information When do you plan to start your application? —Please choose an option—ImmediatelyIn the next 3 monthsIn 6-12 monthsI'm not planning yet What is the best way to approach you? EmailSkypeWhatsAppPhone call
