Canada Immigration Assessment Preliminary Assessment Questionnaire For Permanent Residency Application / Temporary Residency Application Applicant's First Name (required) Applicant's Middle Name Applicant's Last Name (required) Any other Name used previously Date of Birth Place of Birth (Place, Country) Full Mailing Address Residential Address (if different) Home Phone Number With Country and Area Code Cell Phone Number With Country and Area Code Skype Id Email (required) Other Email (If Applicable) Gender MaleFemaleOthers Martial Status (required) Marriage Date Nationality Referred by Principal Applicant: Please mention all your academic activities starting with most recent graduation. Type of Graduation Univerisity / College Name / Country From (mm/yyyy) To (mm/yyyy) -+ Principal Applicant: Please mention all your experience you have gained after your graduation. Company Name Designation From (mm/yyyy) To (mm/yyyy) -+ Principal Applicant: IELTS Result (General Module) Language Test: CELPIPIELTS Given IELTS? Yes / No Reading Writing Speaking Listening Overall Band Test Pass Date Ability in English and French English Reading HighModerateBasicNot At All Writing HighModerateBasicNot At All Speaking HighModerateBasicNot At All Listening HighModerateBasicNot At All French Reading HighModerateBasicNot At All Writing HighModerateBasicNot At All Speaking HighModerateBasicNot At All Listening HighModerateBasicNot At All Spouse Information Spouse First Name Spouse Middle Name Spouse Last Name Any other Name used previously Date of Birth Place of Birth (Place, Country) Full Mailing Address if different than Applicant's Number of Children Cell Number with Country and Area Code Full Name(First Name, Last Name) Email Nationality Gender Children Infornmation Full Name Date of Birth Nationality Gender -+ Spouse : Please mention all your academic activities starting with most recent graduation. Type of Graduation Univerisity / College Name / Country From (mm/yyyy) To (mm/yyyy) -+ Spouse : Please mention all your experience you have gained after your graduation. Company Name Designation From (mm/yyyy) To (mm/yyyy) -+ Spouse: IELTS Result (General Module) - if available Reading Writing Speaking Listening Overall Band Test Pass Date Do you or your spouse have applied / Refuse for Canada or any other Country? i.e. PR Application, Student, Visitor, Work Permit, etc. (Write Yes/No with full details below) Yes/No - if yes give details. -+ Do you or your spouse currently living in Canada? If yes, please provide detials below. Full Name of the Applicant Canada Status in Canada (i.e. Visitor, Worker, Student) Permit Start Date Permit Expiry Date Do you or your spouse have any relatives in Canada? i.e. Parents, Grand Parents, Brother, sister, nephew, cousin, uncle, aunt. (If yes write full details below) Full Name of Relative in Canada Address of Relative(City / State name only) Relationship Status of Relatives(PR/Citizen) -+ Travel Information (If you have travel outside of your origin country please write full details below) Name of the Country Status in Foreign Country To (dd-mm-yyyy) From (dd-mm-yyyy) -+ * I understand that my first meeting with Sharp International Immigration Services (SIIS) includes an initial brief free assessment of my circumstances to see if I qualify for making an application to Canada Immigration. Sharp International Immigration will not accept clients who do not qualify.*I will declare at the beginning of the meeting if I am here to discuss any matters that deal with an existing problem with Canada Immigration, an application that has already been submitted, to go into depth on my personal immigration circumstances, or an application which I intend to prepare and submit on my own, as these are NOT included in SIIS' free assessment, and I agree to pay for the entire consultation at SIIS' current hourly rate. I agree to provide complete and truthful information in the interview.
