Canadian Immigration Assessment Questionnaire
This Questionnaire consists of 12 Steps. At any Step, feel free to click on the
button for helpful hints and tips regarding completion of that section of the Questionnaire.
  Step 1: Applicant - Personal Details
 
Please complete the questionnaire below so that we can return your FREE online assessment.
Once completed, please press the submit button found at the bottom of this page.
 
 Family or Surname  First Name  Title         Gender
   
 Current Address - Street Name Apartment Number  City 
   
 State/Province  Zip/Postal Code  Country
   
  How long resident in this country  Telephone Number  Business Telephone
   
 E-mail Address ( must be correct)  Mobile/Cellular Number  Fax Number
   
  Date of Birth  City or Town of Birth  Country of Birth
   
 Marital Status  No of Children - Ages  List other countries in which you have  legally resided for more than 1 year.
 

Step 2: Applicant -  Education Details

 
Enter in the boxes below the number of years and months completed at each educational level.
Please enter the total number of years completed at EACH LEVEL (e.g. Primary School - 8, Secondary
School - 5, First Bachelor degree - 3, Further Bachelor degree - 3). Enter zero (0) if not applicable.
Full Time Higher Education (i.e. post-secondary study)
PhD: 
Years Months
Master Degree: 
Years Months
Further Bachelor Degree: 
Years Months
First Bachelor Degree: 
Years Months
Diploma: 
Years Months
Certificate: 
Years Months
Apprenticeship: 
Years Months
School Education (i.e. secondary school/high school)
Secondary_High School: 
Years

Creche_Kindergarten plus Primary School: 
Years

Total: 

 <Press to Calculate
FAILURE TO ACCOUNT FOR ALL YEARS OF STUDIES WILL RESULT IN A LOWER EDUCATION SCORE AND POSSIBLE DISQUALIFICATION.

 

Confirm Highest Level of Education completed:

 

Exact details of Highest Qualification Received: 
eg. BSc. Engineering

Step 3: Applicant -  Work Experience       
                          

In the space below, please account for all of your PAID FULL-TIME (37.5 hours per week or the equivalent thereof) work experience within the past 10 years. Click the "Select" button to choose the appropriate job title and indicate the starting and ending month/year by using the pull-down menus provided.

 

 

From

To

Job Title/Description

 

Month
Year
Month
Year
Please select using buttons below

  Present Job
 

  2nd last
 

  3rd last
 

  4th last
 

  Other
 


Step 4: Applicant -  Language Ability    
 
 
Is French your first language ?  
 
  
 

 

 Speak
Write
 Read
 Understand
English
French

 

Step 5: Applicant - Financial Information     
 
 
  Indicate here your personal net worth in US Dollars. Enter amount in
  numbers only - do not use commas, spaces or decimal points.
   To calculate your total personal net worth, you must do the following:

  1. List all of your fixed assets, such as real estate and cars, at their current value.
   2. List all of your liquid assets: cash, certificates of deposit, stocks,
   bonds and bank accounts.
   3. List all jewelry, furniture and household items at their current value.
   4. Add all of the above. These are your total assets.
   5. Subtract all of your debts, such as your mortgage, car loan and credit
   card balances, from your total assets.
   IE:- (1 + 2 + 3) - (5) = your total personal net worth.  


Total net worth
( in USD only. Do not use commas, spaces or decimal points -
eg. 10000)

$US


Step 6: Spouse_Partner -   Personal Details   (if applicable)    
 

Do you have a Spouse_Common-Law Partner/Same-Sex
Partner ?  If 'No' Click on Skip to Step 10
..Yes   No
Family/Last name:  

First/Given name:

 Title:  

Gender

e-mail Address:  

Date of Birth:


 
Step 7: Spouse_Partner:  Education Details (if applicable)       
                    
  Enter in the boxes below the number of years and months completed at each educational level.
   Please enter the total number of years completed at EACH LEVEL (e.g. Primary School - 8, Secondary
   School - 5, First Bachelor degree - 3, Further Bachelor degree - 3). Enter zero (0) if not applicable.
Full Time Higher Education (i.e. post-secondary study)
PhD: 
Years Months
Master Degree: 
Years Months
Further Bachelor Degree: 
Years Months
First Bachelor Degree: 
Years Months
Diploma: 
Years Months
Certificate: 
Years Months
Apprenticeship: 
Years Months
School Education (i.e. secondary school/high school)
Secondary_High School: 
Years

Creche_Kindergarten plus Primary School: 
Years

Total: 

 <Press to Calculate
FAILURE TO ACCOUNT FOR ALL YEARS OF STUDIES WILL RESULT IN A LOWER EDUCATION SCORE AND POSSIBLE DISQUALIFICATION.

 

Confirm Highest Level of Education completed:

 

Exact details of Highest Qualification Received

eg. BSc. Engineering

Step 8: Spouse_Partner -  Work Experience (if applicable)                
 
In the space below, please account for all of your PAID FULL-TIME (37.5 hours per week or the equivalent thereof) work experience within the past 10 years. Click the "Select" button to choose the appropriate job title and indicate the starting and ending month/year by using the pull-down menus provided.

 

 

From

To

 

 

Month
Year
Month
Year
Job Title/Description

  Present Job

  2nd last

  3rd last

  4th last

  Other
 

 Step 9: Spouse_Partner -  Language Ability (if applicable)     
 
Is French your first language ?
  

 

 Speak
Write
 Read
 Understand
English
French

 Step 10: Additional Questions for Applicant and Spouse_Partner (if applicable)
 
Do you have a job offer from a prospective Canadian employer ?
Do you have HRDC confirmed offer of employment in Canada ?
Have you worked in Canada for 1 year or more in full-time authorised
employment ?
Have you studied in Canada for 2 years or more full-time authorised
post-secondary study ?
Do you have a relative who is a Canadian Citizen or Permanent Resident ?
Only direct blood relatives NOT cousins and/or family friends.


Step 11: Final Questions    
 
 

 Have you, your Spouse_Partner, or any of your dependants ever:

 

 had any serious disease or physical or mental disorder ?
 been convicted of or are currently charged with any crime or offence in any country ?
 applied previously for temporary status in Canada (i.e. visitor/student/worker) ?
 been refused a Canadian immigrant visa /visitor visa /Study Permit /Work Permit
  or that of any other country ?
 been refused admission to, or ordered to leave Canada or any other country ?
 been involved in the commission of a war crime or a crime against humanity ?
 applied previously for permanent status in Canada ?
 

 

 


If you have answered "yes" to any of the questions in Steps 10 OR 11, above, please provide details, below: