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General Assessment
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Step
1
of 6
SECTION A: PERSONAL DETAILS
Name (as it appears on your passport)
*
First
Last
Date of Birth
City and Country of Birth
Country(ies) of Citizenship (list all)
Please indicate all languages you are able to communicate in (select box):
English
French
Native Language / Mother Tongue
List languages below
SECTION B: CONTACT DETAILS
Provide your current residential address (this is the address where you physically live):
Provide your current mailing address (if different from your residential address):
Email Address:
*
Home Number:
Cell Number:
Work Number:
Next
SECTION C: ADMISSIBILITY
Important Instructions: Review these questions with EXTREME care.
Do any of the following questions apply to you:
a) Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in contact with a person with tuberculosis?
Yes
No
b) Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?
Yes
No
c) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada? Keep in mind that if you ever had to restore your status in Canada, then the answer to this question would be “yes”.
Yes
No
d) Have you ever applied for OR been refused refugee status in ANY country?
Yes
No
e) Have you ever applied for OR been refused a permanent resident visa in ANY country?
Yes
No
f) Have you ever applied for OR been refused a visitor or temporary resident visa in ANY country?
Yes
No
g) Have you ever applied for OR been refused a work permit in ANY country?
Yes
No
h) Have you ever applied for OR been refused a study permit in ANY country?
Yes
No
i) Have you ever applied for OR been refused for ANY other type of visa, permit, etc. than those listed above, in ANY country?
Yes
No
j) Have you ever been refused admission to (i.e. stopped at the border and not allowed to enter), or ordered to leave, Canada or ANY other country?
Yes
No
k) Have you EVER applied to enter or remain in Canada? Applied could mean applying for a visa OR if you are visa-exempt it could mean arriving at a border (land or airport) and not being allowed to enter the country.
Yes
No
l) Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country?
Yes
No
m) Did you ever serve in any military, militia, or civil defense unit or serve in a security organization or police force (including non-obligatory national service, reserve or volunteer units?
Yes
No
n) Are you, or have you ever been, a member or associated with any political party, or other group or organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?
Yes
No
o) Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?
Yes
No
If you answered yes to any of the questions above, please provide details:
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SECTION D: TRAVEL HISTORY
1. If you are NOT currently in your home country and living outside of your country of citizenship, please provide the following details:
In what country are you currently living
Purpose of visit:
Date of Entry:
Date when your status expires/you must leave the country:
2. In the past 10 years, have you lived in any country for 6 months or longer, except for your country of citizenship?
Yes
No
Country Visited:
Your status (include countries that you entered illegally):
Purpose of visit:
Date of Entry:
Add
Add Country?
Date of Exit:
Country Visited:
Your status (include countries that you entered illegally):
Purpose of visit:
Date of Entry:
Add 2
Add Country?
Date of Exit:
Country Visited:
Your status (include countries that you entered illegally):
Purpose of visit:
Date of Entry:
Date of Exit:
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SECTION E : PROFESSIONAL DETAILS
PERSONAL HISTORY CHART (last 10 years):
From
To
Work / Business description
(what were you doing in this period. If employed, state your job title)
Location
(City / Country)
Status in Country
Employer or Institution Name
Add more employment?
Yes
No
From
To
Work / Business description
(what were you doing in this period. If employed, state your job title)
Location
(City / Country)
Status in Country
Employer or Institution Name
Add more employment ?
Yes
No
From
To
Work / Business description
(what were you doing in this period. If employed, state your job title)
Location
(City / Country)
Status in Country
Employer or Institution Name
SECTION F: EDUCATION DETAILS
1. Do you have any post-secondary education? Post-secondary education is schooling obtained after grade 12.
Yes
No
If you answer yes, please provide details of your highest level of post- secondary education in the chart below. If you attended more than one institution to obtain your diploma/degree/etc., please provide information for all institutions.
Institution/School Name:
From
To
Field of Study (ex. Administration, Chemical Engineering, etc.):
City/Country:
Level:
Type of Certificate or Degree/Diploma received (ex. Bachelor’s Degree, etc.):
Institution/School Name:
From
To
Field of Study (ex. Administration, Chemical Engineering, etc.):
City/Country:
Level:
Type of Certificate or Degree/Diploma received (ex. Bachelor’s Degree, etc.):
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SECTION G: GOVERNMENT & MILITARY DETAILS
1. Have you ever held any government position, regardless of whether it was a paid position or not?
Yes
No
Important Instructions: – This includes any of the following: civil servant, judge, police officer, employee in a security organization – This includes all levels of government (municipal, regional, national)
2. Have you ever been involved in the military or paramilitary in any country?
Yes
No
Important Instructions: – This includes: If you actively served in the military or were a member of the reserves or never actively served, and/or never received training, but were registered as a “member” of the military in any country
SECTION H: MARITAL AND CHILDREN DETAILS
Are you married?
Yes
No
If you are married will your spouse apply to Canada?
Yes
No
Do you have any children?
Yes
No
Paragraph Text
Please write how many children you have and their age.
If you have children, will they apply to Canada?
Yes
No
SECTION I : LANGUAGE TEST
Have you taken a test on Academic / General IELTS?
Yes
No
Type
Academic
General
Writing
Reading
Listening
Speaking
Please mention the result publishing date
(DD-MM-YYYY)
SECTION J : PROOF OF FUND
How much money do you have in your possession which is liquifiable? Means, the money you have in the bank. Your property, car, gold, invested in business / share market etc. does not count.
Please mention the amount in CAD$. To convert the rate, please take the rate from the central bank of your country.
could all Location
SECTION K : FIRST BLOOD RELATIVE IN CANADA
Do you or your spouse (if married) have any first blood relative living in Canada?
Yes
No
The relationship between you and the relative living in Canada.
Their current address (City and Province only) of Canada
The date they started staying in the above address
Their residency status (PR / Citizen / Student / Worker)
Please list your TOP 5 questions for the consultation:
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