General Assessment

Name *

First

Last

Phone Numbers

Email *

Country *

Age *

Date of Birth

Marital Status

Do you have any Dependent Children?

Dependent Children includes all unmarried children that are financially dependent on you, who are less than 19 years old. How many dependent children do you have, according to the following age groups: 12 years and younger: *

13 to 18 years:

19 years and older:

What is your Country of Residence? City? *

What is your preferred destination in Canada? *

Pre-existing Express Entry profile ... Have you previously submitted an Express Entry profile to Citizenship and Immigration Canada?

Your Language Skills English: SPEAK *

Your Language Skills English: LISTEN *

Your Language Skills English: READ *

Your Language Skills English: WRITE *

Your Language Skills French: SPEAK

Your Language Skills French: LISTEN

Your Language Skills French: READ

Your Language Skills French: WRITE

IELTS Scores: If you have completed IELTS then in which category ? *

Date of IELTS Test Report (DD/MM/YYYY)

IELTS Speak Score

Selected Value: 5.65

5, 5.5, 6, 6.5, 7, 7.5

IELTS Write Score

Selected Value: 5

5, 5.5, 6, 6.5, 7, 7.5

IELTS Listen Score

Selected Value: 5

5, 5.5, 6, 6.5, 7, 7.5

IELTS Reading Score

Selected Value: 5

5, 5.5, 6, 6.5, 7, 7.5

Your Education and Training

Have you Completed your Educational Credential Assessment (ECA)?

What is your ECA Level Certified as

What is your highest level of education and in which field? * Have you received any education or training other than high school (secondary school)?

Current (or most recent) Program of Study Type of Program

Program Name and Field (e.g MBA Finance/B.A. Economics/B.S.C. Biology) Teaching Method

Program Duration

Did you complete this program?

Your Work History: Do you have at least one year of related work experience during the last 5 years? *

Do you have any paid work experience outside of Canada during the last 10 years?

Total Paid Work Experience (In Months) *

For your current (or most recent) job, please provide details: Occupation

Length of Work

Choose time

When

Type of job

Location

Province

Residency Status:

Canadian Job Offer: Do you have a written job offer from a Canadian employer?

Occupation:

Province:

Family and Friends in Canada: Do you have any family members, relatives, or close friends living in Canada? *

Please list all family members, relatives, and close friends who are currently living in Canada This Person is your: *

Relationship: * Residency Status: * Living In: * Since: *

Your Spouse/Common-Law Partner’s Information *

Salutation: • Mr. • Ms. Spouse First Name Spouse Last Name

How old is your Spouse/Common-Law Partner?

Age

Single Line Text

Your Spouse/Common-Law Partner’s Language Skills English: Speak

Speak : • Advanced • Intermediate • High intermediate • Low intermidiate • Basic • No skills

Read

• Advanced • Intermediate • High intermediate • Low intermidiate • Basic • No skills

Write

• Advanced • Intermediate • High intermediate • Low intermidiate • Basic • No skills

Listen

• Advanced • Intermediate • High intermediate • Low intermidiate • Basic • No skills

Paragraph Text

Speak French

Read French

Write French

Listen French

Please provide information about your Spouse or Common-Law Partner’s work experience:

Occupation:

Length of Work:

Has your Spouse or Common-Law Partner ever worked in Canada in a skilled occupation for at least one year?

Your Spouse/Common-Law Partner’s Education Has your Spouse/Common-Law Partner completed high school (secondary school)?

Has your Spouse/Common-Law Partner received any education or training other than high school (secondary school)?

IELTS Scores: If you have completed IELTS then in which category

Date of IELTS Test Report (DD/MM/YYYY)

**IELTS Speak Score **IELTS Read Score **IELTS Write Score **IELTS Listen Score

Your Spouse/Common-Law Partner’s Education and Training Have you Completed your Educational Credential Assessment (ECA)?

What is your ECA Level Certified as

What is your highest level of education and in which field? Have you received any education or training other than high school (secondary school)?

Spouse’s Current (or most recent) Program of Study Type of Program:

Program Name and Field (e.g MBA Finance/B.A. Economics/B.S.C. Biology) Teaching Method

Program Duration:

Location Did you complete this program? Did you complete this program? (copy) Networth of Applicant's Immovable Assets including that of spouse (Value in Canadian Dollars) *

Questions and Comments

Please use this space to send any specific questions, comments or additional information that may be relevant to your inquiry.