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IMMIGRATION TO CANADA

Canada Skilled Immigration

Canadian Immigration Assessment Form for Independent (Skilled Workers) Immigration

About You

Title *

First name *

Last name *

Date of birth *

Place of birth *

Gender *

MaleFemale

Nationality *

Country of Residence*

Present occupation *

Nominated occupation *

How long have you been working in nominated occupation? *

Annual Income (Can$)

Please see universal currency convertor for exchange rate

Present address

Street Address

Town/City

Post Code/Zip Code

Country

Contact details

Telephone

Fax

E-mail *

Web page

Immigrationdetails

Your plans for Immigration*

Do you have family or dependants who will emigrate with you? *

YesNo

If "Yes" please give details

Age	Relationship to you	Occupation

Do you or your spouse/common law partner have relatives or ancestors in Canada?

Age	Relationship to you	Occupation	Nationality	Immigration Status

Have you had any type of visa to Canada before? *

YesNo

If yes, please give the following details

Type Date Issued Place Issued Length of validity

Have you ever been refused a visa? *

YesNo

If yes, please give details

Have you or any of your immediate family members ever been convicted of any crime (however minor the offence)?*

YesNo

If yes, please give details

Have you or any of your immediate family had any serious health problems?*

YesNo

If yes, please give details

Why do you wish to emigrate?

Funds

Please see universal currency convertor for exchange rate

How much do you have in the way of funds? (in Can$)

Savings on deposit

Value of other assets

Amount you intend to take with you

English language ability

Speaking *

NoWith difficultyWellFluent

Reading *

NoWith difficultyWellFluent

Writing *

NoWith difficultyWellFluent

Understanding *

NoWith difficultyWellFluent

French language ability

Speaking *

NoWith difficultyWellFluent

Reading *

NoWith difficultyWellFluent

Writing *

NoWith difficultyWellFluent

Understanding *

NoWith difficultyWellFluent

Job offer in Canada

Do you have a job offer *

YesNo

If so what is the occupation?

Has the job been approved by Human Resources Development Canada?

YesNo

Work Experience

Total years of skilled level experience

1. Work experience

Dates of Employment *
dd/mm/yyyy - dd/mm/yyyy

Employing Company *

Job Title *

Skills used /Responsibilities *

Country *

2. Work experience

Dates of Employment
dd/mm/yyyy - dd/mm/yyyy

Employing Company

Job Title

Skills used /Responsibilities

Country

3. Work experience

Dates of Employment
dd/mm/yyyy - dd/mm/yyyy

Employing Company

Job Title

Skills used /Responsibilities

Country

Qualifications

Total years or equivalent of full-time education from 1st year at school

1. Qualification

Dates of study *
dd/mm/yyyy - dd/mm/yyyy

University/College/School *

Subject *

Qualification *

Country *

2. Qualification

Dates of study
dd/mm/yyyy - dd/mm/yyyy

University/College/School

Subject

Qualification

Country

3. Qualification

Dates of study
dd/mm/yyyy - dd/mm/yyyy

University/College/School

Subject

Qualification

Country

Work Experience for your Spouse or Common Law Partner

1. Work experience

Dates of Employment
dd/mm/yyyy - dd/mm/yyyy

Employing Company

Job Title

Skills used /Responsibilities

Country