Name*
Email*
Country of residence*
State*
City*
Country of citizenship*
Age*
Phone
Dependent children*YesNo
Age of children
Marital status* —Please choose an option—UnmarriedMarried/Common-Law Partnership
Spouse age*
Spouse’s level of education and duration* —Please choose an option—Diploma - 1 yearDiploma - 2 yearsDiploma - 3 yearsBachelor’s- 2 yearsBachelor’s - 3 yearsBachelor’s - 4 yearsMaster’s DegreeDoctorate or PhDother
Spouse’s language ability in English
Reading* BeginnerIntermediateAdvancedNone
Writing* BeginnerIntermediateAdvancedNone
Speaking* BeginnerIntermediateAdvancedNone
Listening* BeginnerIntermediateAdvancedNone
Spouse’s language ability in French
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*
Spouse’s Job Title/Field of Work Experience*
Do you have any diploma/certificate which attest your abilities*
Have you received any post-secondary education or training?* YesNo
Type of certificate* —Please choose an option—Diploma - 1 yearDiploma - 2 yearsDiploma - 3 yearsBachelor’s- 2 yearsBachelor’s - 3 yearsBachelor’s - 4 yearsMaster’s DegreeDoctorate or PhDother
Field of study*
Date of graduation*
Name of institution*
Country*
Current
Job title*
From (year/month)*
To (year/month)*
Employment status* —Please choose an option—Full Time – more than 30 hours per weekPart Time – less than 30 hours per week
Employment duties*
Add another job? —Please choose an option—YesNo
Do you or your spouse/common-law partner have any close family members above 18 years old who are permanent residents or Canadian citizens and live in Canada now?* YesNo
If you answered Yes to the above:
Relationship to Closest Blood Relative in Canada (Parent, grandparent, child, grandchild, brother or sister, aunt or uncle, niece or nephew)
Do you currently have an offer of employment from a Canadian employer? YesNo
Provide details
Have you or your spouse/common-law partner or dependent children ever:
Had any serious disease or physical or mental disorders YesNo
Been convicted or currently charged with any crime or offence in any country YesNo
Previously applied for refugee status or visa to Canada YesNo
Been refused refugee status or visa to Canada YesNo
Visited Canada (visit, study, work) YesNo
If your answer to any of above is “Yes” please provide details
Additional questions and comments
