NETWORK


	All information provided by you will be kept in strict confidence.
	All information will be used for the sole purpose of this evaluation.
	In order to receive a detailed evaluation, please give us as much information as possible.
	We will not evaluate incomplete questionnaires.

Personal Information

Last Name: (Required)		First Name: (Required)
Nationality:		Country of residence:
City of residence:		Address:
Telephone:		Fax:

Date of Birth:

Age: (Required)

Gender:

Marital Status:

Height:

Number of children:

Their Ages:

Email:

*Note: In order to receive a reply, kindly ensure that you have sufficient space in your e-mail account. In addition, for Hotmail and Yahoo users our reply may be filtered as "Junk Mail"

Educational Background

Select the highest degree that you currently have

Select the highest level of Post Graduate degree that you currently have

*Note: If you are Medic or Lawyer, please verify that your title has a Phd level.

Years of completed primary and secondary school:
Years of completed undergraduate studies:
Years of completed post graduated studies:

Name of Highest Degree obtained:

Major:

Comments on your education (name of degrees and duration of studies)

Spouse’s / Partner’s Education (same or different sex)

Select the highest level of education

Years of study

Name of Degree Obtained:

Spouse’s / Partner’s DOB:

Note: If you have a spouse/partner who is employed, he/she should also complete and submit an Online Assessment Form

Experience in Canada

I have legally worked in Canada for at least one year

I have legally studied in Canada for at least two years

I have a Human Resources Development Canada (HRDC) confirmed offer of employment in Canada

Work Experience

Total number of completed years of working experience: (Required)

Most recent job

Dates worked

From:

To:

Hours per week:

Title:

Responsibilities:

Previous Job

Dates worked

From:

To:

Hours per week:

Title:

Responsibilities:

Previous job

Dates worked

From:

To:

Hours per week:

Title:

Responsabilities:

Previous job

Dates worked

From:

To:

Hours per week:

Title:

Responsabilities:

Language Ability

I have studied english in a language academy

I have studied french in a language academy

I have completed my post – secondary education in English

I have completed my post – secondary education in French

I have a university degree in English

I have a university degree in French

Ability	Speak	Read	Write	Listen
English
French

Note: You do not need to know both languages to be eligible for a Canadian Residence Visa

Additional Information

Do you (or your accompanying spouse/partner) have a relative legally residing in Canada? If so, please provide us with the relationship of the closest relative and the Province or Territory in which your relative resides

Relationship:
Location (Province):

Note: Only relatives with direct relation will be considered

Financial Self Sufficiency

Do you own a business or are you currently managing a business?
Have you owned or managed a business in the past?

Are you interested in starting a business or investing in a business, in Canada?

What is the value of your liquid assets?
(money in the bank, stocks/bonds, other negotiable, etc.)

What is the value of your capital assets?
(properties, land, equipment, etc.)

Note: The applicant must have enough resources to cover his/her family expenses for the first three months of residence in Canada

Comments

You may also make inquiries, or address issues about medical, criminal, and previous applications issues.

How did you hear about us?:

Please, specify

I would like to subscribe to your Immigration Newsletter

Further Information

Have you, or any of your dependants ever (If yes, check box)

Been convicted of or currently charged with any crime/offence in any country?

Had any serious disease?

Applied previously for an immigrant visa or temporary visa (student/work/visitor) to Canada?

If you checked any of above, please provide details:

Note: If you marked one of the above questions, you can still qualify for a residence visa in Canada

By signing this form, I hereby declare that the information being transmitted is truthful, complete, and accurate to the best of my knowledge

For office use only
File Number :

If you have French skills and if you are interested to be assessed under the Quebec program,
please click here