Pre-Application Questionnaire for Immigration to Canada

Please note:
A family’s eligibility may be assessed on the basis of the qualifications of either spouse. Please complete one form for each spouse.

*
 = required field

 
* Date: (dd/mm/yyyy)
Personal Information:
* Last Name:
* First Name:
* Present Address:
Telephone:  
* Home:
* Business:
Facsimile:
* E-mail:
Date of Birth: (Month, day, year)
Current Age:
Place of Birth:
Citizenship:
Marital Status
Married Separated
Divorced Widowed
Never married
Sex
Male Female
Number of Children:
Age(s)
* Do you or your spouse have any of the following relatives in Canada who are either Canadian citizens or permanent residents and who currently reside in Canada ?
   
Mother Father
Grandmother Grandfather
Brother Sister
Aunt Uncle
Niece Nephew
None    
Immigration Status in current country of Residence:
Education:  
* Please check any of the following statements which apply to you and, where applicable, indicate the name of the institution you attended as well as the name of the diploma or degree you received:
I have not completed secondary/high school.
I have completed a secondary school educational credential.
I have completed secondary/high school, but have completed a one-year diploma, trade certificate of apprenticeship AND have a total of 12 years full-time or full-time equivalent studies.
I have completed a one-year diploma, trade certificate or apprenticeship AND have a total of 13 years full-time or full-time equivalent studies.
I have completed a two-year diploma, trade certificate or apprenticeship AND have a total of 14 years full-time or full-time equivalent studies.
I have completed a three-year diploma, trade certificate or apprenticeship AND have a total of 15 years full-time or full-time equivalent studies.
I have completed a one-year university degree at the Bachelor’s level AND have a total of 13 years of full-time or full-time equivalent studies.
I have completed a two-year university degree at the Bachelor’s level AND have a total of 14 years of full-time or full-time equivalent studies.
I have completed two or more university degrees at the Bachelor’s level AND have a total of 15 years of full-time or full-time equivalent studies.
I have completed a PhD, or Master’s AND have a total of 17 years full-time or full-time equivalent studies.
* Name of the institution at which studies were completed and the country where studies were completed:
Name or type of diploma or degree received and area of specialization:
If married, spouse’s highest level of education (based on descriptions above):
Present Occupation:
Job Title:
Name of Employer:
Experience:
From (dd/mm/yy):
To (dd/mm/yy):
Job Duties:
Previous Occupation 1:
Job Title:
Name of Employer:
Experience:
From (dd/mm/yy):
To (dd/mm/yy):
Job Duties:

Previous Occupation 2:
Job Title:
Name of Employer:
Experience:
From (dd/mm/yy):
To (dd/mm/yy):
Job Duties:
Previous Occupation 3:
Job Title:
Name of Employer:
Experience:
From (dd/mm/yy):
To (dd/mm/yy):
Job Duties:
Previous Occupation 4:
Job Title:
Name of Employer:
Experience:
From (dd/mm/yy):
To (dd/mm/yy):
Job Duties:
Arranged Employment in Canada:
Do you have arranged employment in Canada which has been validated by a Human Resource Development Canada office through an application made by your prospective employer?
Yes No
* Language Skills:
English High Proficiency Moderate Proficiency Basic Proficiency Not At All
* Speak
* Read
* Write
* Listen
         
French High Proficiency Moderate Proficiency Basic Proficiency Not At All
* Speak
* Read
* Write
* Listen
Assets & Liabilities:
(1) Please provide an estimate of the total value of assets which you currently hold:
 
(2) Please provide an estimate of the total value of your liabilities:
 
(3) Please provide an estimate of the value of the funds which you anticipate being able to transfer to Canada upon your relocation:
 
Previous Work/Study in Canada
(1) Myself or my spouse (if applicable) has previously held a valid Canadian employment authorization and did engage in at least one year of full-time employment in Canada:
  Yes No
(2) Myself or my spouse (if applicable) has previously held a valid Canadian student authorization and, after the age of seventeen, completed a two-year program of full-time study at a post-secondary institution in Canada.
  Yes No
Other:  
(1) Do you or any other member of your family have:
  * (a) any past or present medical conditions:
  No Yes (please explain in the box below:)
 
  * (b) any past criminal history in Canada or any other country:
  No Yes (please explain in the box below:)
 
  (c) any past Canadian immigration history:
  No Yes (please explain in the box below:)
 
(2) * How were you referred to us?
 



*
 = required field