Free Consultation » Personal Form

This Preliminary Questionnaire has been developed to assist you in determining whether you will be successful in your application to immigrate to Canada. Fill in the questionnaire as accurately and truthfully as possible and click send below.

If you are married or living common-law click here to fill out spousal form.

Personal Information
Name:
Address:
City:
State/Prov:
Country:	AlgeriaAntiguaArgentinaArubaAustraliaAustriaBahamasBahrainBangladeshBarbadosBelgiumBelizeBermudaBoliviaBonaireBotswanaBr. Virgin IslandsBrazilBulgariaBurmaCanadaCayman IslandsChileChinaColombiaCosta RicaCubaCuracaoCyprusCzech RepublicDenmarkDominicaDominican RepublicEcuadorEgyptEl SalvadorEnglandEstoniaEthiopiaFijiFinlandFranceFrench GuianaGermanyGhanaGreat BritainGreeceGrenadaGuadaloupeGuamGuatemalaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKenyaKoreaKuwaitLatviaLebanonLesothoLiechtensteinLuxembourgMacauMalaysiaMaltaMartiniqueMauritiusMexicoMicronesiaMonacoMoroccoNamibiaNepalNew CaledoniaNew ZealandNicaraguaNigeriaNorthern IrelandNorwayOmanPakistanPanamaPapau Nw GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint MartinSamoaSan SalvadorSaudi ArabiaScotlandSingaporeSlovak RepublicSloveniaSouth AfricaSouth KoreaSpainSri LankaSurinamSwazilandSwedenSwitzerlandSyriaTaiwanTanzaniaTemp CountryThailandThe NetherlandsTrinid & TobagoTrinidadTurkeyUnited Arab EmiratesUnited KingdomUnited StatesUruguayVenezuelaVirgin IslandsWalesWest IndiesYemenYugoslaviaZimbabwe
Home Phone:
Work Phone:
Email:
Date of Birth:(dd/mm/yy):	/ /
Citizen of Country(ies):
Passport Number:
Country of Issue:
Your Status in Country of Present Residence:	Citizen Immigrant Illegal Other (Please state)
Sex:	Male Female
Present Marital Status:	Single Married Engaged Divorced Separated Widowed
Name of Spouse:
Date of Birth of Spouse: (dd/mm/yy)	/ /
Childrens Name Date of Birth (dd/mm/yy) Marital Status Full-Time Student Country of Birth / / Yes No / / Yes No / / Yes No / / Yes No
Do you or your spouse have a relative in Canada?	Yes No
If yes, relationship to you or your spouse:
Relatives name, address and phone:
Employment History for the past 10 years.
Name of Employer City/Country Occupation From (mm/yy) To (mm/yy) / / / / / / / /
Intended Occupation(s) in Canada
Have you ever owned, operate or controlled a business?	Yes No
If yes, details:
Do you have employment arranged in Canada?	Yes No
If yes, your position, along with name, address, telephone number of employer:
Personal Worth:	a) Cash in hand/bank $ b) Property (Including land residential, commercial) $ c) Other assets (Value of busines. etc) $
Educational Background
Are you currently a student:	Yes No
If yes, expected date of graduation.(dd/mm/yy)	/ /
Details of Secondary and Post Secondary Education (High School, University, College, Apprenticeship Training) Name of School (include city and country) Program of study From (mm/yy) To (mm/yy) Degree/Diploma / / / / / / / /
Any other on the job training?	Yes No
Details:
Do you speak English or French?	Fluently With difficulty Well Not at all
Do you read English or French?	Fluently With difficulty Well Not at all
Do you write English or French?	Fluently With difficulty Well Not at all
Do you or any of your family suffer from medical problems?	Yes No Details:
Have you or any of your family been convicted of a criminal offence?	Yes No Details:
Have you or any of your family applied to immigrate to Canada before?	Yes No Details:
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