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This questionnaire is not a legal document. The following questions will help us find the best possible option to process your permanent residence in Canada application. All the information that you provide is confidential. Please answer the questions clearly and in detail. If you are married or engaged, please have your spouse/fiancé complete another questionnaire. Should you have children over the age of 19, please have them complete a questionnaire as well.

APPLICANT
Title:
First Name:
Middle Name:
Last Name:
Country of Residence:
Citizenship(s):
Address:
E-mail:
Tel.:
Fax:
Date of Birth or Age:
Marital Status:
Number of Children:
Ages of Children (#,...,#):
 
Do you have family/relatives who are Canadian citizens or permanent residents?* No
Yes

EDUCATION
Indicate your highest level of education:

WORK EXPERIENCE
List all of your full-time, paid work experience accumulated in the past 10 years:
JobTitleDuties# of
months
Do you have a full-time permanent job offer from a Canadian employer?
No
Yes

Has the job offer been confirmed by Service Canada (HRSD)?
No
Yes

LANGUAGE SKILLS
Indicate your language skills in English and French:

English
SpeakingListeningReadingWriting

French
SpeakingListeningReadingWriting

Indicate your score if you have recently taken one of the following tests:
TestResults
IELTS
CELPIP
TEF

ASSETS & LIABILITIES
Indicate total value of your assets and liabilities:
AssetsCDN$
LiabilitiesCDN$

How much money do you anticipate to bring/transfer to Canada upon your relocation to Canada?
CDN$

BUSINESS OWNERSHIP / MANAGEMENT
Answer the following questions if you have owned and/or managed a business in the past 5 years:
What type of business have you owned and/or managed?
Corporation
Partnership
Sole proprietorship
Provide the following data for your business in past 5 fiscal years
YearAnnual Sales CDN$Net Income CDN$Net Assets CDN$% of business owned# of Employees

ADDITIONAL INFORMATION

Does any of your family members (including yourself) have health problems?
No
Yes
Describe

Has any of your family members (including yourself) committed any criminal offences (in Canada or any other country)?
No
Yes
Explain

Has any of your family members (including yourself) ever applied for immigration to Canada?
No
Yes
Details

Has any of your family members (including yourself) ever been refused a visa or entry to Canada or deported from Canada?
No
Yes
Details

Please provide any other information that might assist in this assessment: