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Free Evaluation Form

The following is to be completed by persons who have submitted an application for Canadian permanent residence to a Canadian visa office outside Canada, prior to January 1, 2002 and have not yet been scheduled for a selection interview.
Personal Information
Name:
Email Address:
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".
Nationality:
Current Place of Residence: (City,Country)
Daytime Telephone number preceded by the area code: (areacode , phone number)
Home, Office, or Mobile
Date of Birth:  
 Day        Month             Year
Sex: Male Female
Marital Status : Single

Married

Divorced/Separated
If Married, please provide Spouse's Characteristics in the fields below
Spouse's Date of Birth:  
 Day        Month             Year
Spouse's Level of Education and duration:                                       (If other please specify)
Spouse's total years of education:
(Starting from primary school)

Spouse's field of study:


Spouse's Number of Years and Months of Working Experience:

Language Ability in French:
Number of Dependant Children:

Ability in English and French
English
Read
Write
Speak
Listen
French
Read
Write
Speak
Listen

Educational Profile
Total Years of education:
(Starting from primary school)
1. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
2. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
3. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

Employment History
1. Name of Company/Organization:
Job Title:
From: (Month, Year) To Present
Employment Status: Part Time
Full Time
Employment Duties:

(please provide details)
City:
Country:
2. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Employment Duties:

(please provide details)
City:
Country:
3. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Employment Duties:

(please provide details)
City:
Country:

Other
• Relationship to Closest Relative in Canada (Canadian Citizen or Landed Immigrant):
Parent Aunt/Uncle Brother or Sister Son/Daughter

Niece/Nephew (22 years or older) Grand Parent
Relative Province of Residence :

• Personal Net worth ($):

• Do you currently have an offer of employment from a Canadian employer? Yes No
If your answer to the above question is "Yes" provide details here:

• Have you or your spouse or common-law partner ever:
  • Had any serious disease
Yes No
  • Been convicted of or currently charged with any crime or offence in any country
Yes No
  • Applied previously for an immigrant visa to Canada
Yes No
  • Visited Canada (visit,study,work)
Yes No
Are you able to obtain a visitors visa to Canada Yes No
If answer to any of above is "Yes" provide details here:

• Do you currently have a pending application for permanent residence to Canada? Yes No
• If you replied yes to the previous question, please explain in which visa office the application is currently pending?

• In which visa office was the pending application initially submitted?

• In what year was the pending application initially submitted?
• Have you been informed of a selection interview? Yes No
• Please provide any additional information:

• PLEASE INFORM US HOW YOU WERE INTRODUCED TO THIS SITE:
Search Engine (please specify name & keywords used for the search)
Newspaper or Magazine (please specify)
Newsgroup (please specify)
General Recommendation

• Additional Comments if Any:

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