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APPLICATION FOR PERMANENT RESIDENCE IN CANADA

ON-LINE  INITIAL ASSESSMENT FORM                   Click here for TEXT-ONLY VERSION

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UNDER   CONSTRUCTION !

* To obtain a paper copy, press the 'Print' button from your Browser.

* To fill out off-line, click here and follow instructions

I am applying for :  Permanent Resident                       Dependant                      

1. First name  :          Family name :   

2. Sex :  

3. Date of birth (day/month/year)   

4. Country of birth :   

5. I am a citizen of    

6. Address      

Telephone :      E-mail    :   

7. Present marital status :   

8. Number of dependants over 19 years of age :  (excluding spouse) 

9. Number of dependants under 19 years of age :   

10. Ability in English :   Speak :   

                                    Read  :   

                                    Write :   

11. Ability in French :   Speak :   

                                    Read  :   

                                    Write :   

12. Education (indicate number of years of school successfully completed) :

    Primary / High school  years, 

    Pre-University  years, 

    University / College  years, 

    Apprenticeship / Training  years 

13. Details of post-secondary education : 

    Dates  Name of Institution   

    Country  Type of Qualification   

14. My present occupation is   

15. Number of years of relevant experience  years   

Details of employment : Please attach to this file your resume, showing exact job duties. 

16. Do you have a job offer from a person, employer or Organization in Canada ?  

17. Do you have any close relatives in Canada ?          (state relationship) 

18. I have the following assets (show amount or value in Canadian Dollars): 

    Liquid Assets : CAN.  /= 

    Property      : CAN.  /=  

    Other         : CAN.  /=  

    If 'Other', give details here  

19. I have the following debts or legal obligations (e.g. child support payments)  

    Amount CAN.  /=  

20. Any other comments  

I certify that the information contained in this document is complete, accurate and factual. I also realize that this is a preliminary questionnaire, and further details may be required before a final assessment with a money-back guarantee can be given. 

e-mail attachments to : mcutchi@canada.com

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