Pre-Application Questionnaire for Immigration to Canada

7398 Yonge St. Unit 33D, Thornhill, ONL4J 8J2, Canada
CSIC Member Tel: 1(905) 881-1200 Fax: 1(905)881-6442
M052599

Pre-Application Questionnaire for Immigration to Canada

Please note: A family’s eligibility may be assessed on the basis of the qualifications of either spouse. Please complete one form for each spouse.

Date: ------

Personal Information

First & Last Name:

Present Address:

Telephone:Best time to contact you:

FacsimileEmail:

Date of Birth:Place of Birth:

Marital Status:MarriedNever MarriedCommon-Law Separated Divorced Widowed

Sex:MaleFemale

Spouse’s Name (If Applicable):

Spouse’s Education (If Applicable):

Number of Children:Age) s):

Citizenship:

Immigration Status in current country of Residence:

Do you or your spouse have any relatives in Canada who are either Canadian Citizens or permanent residents and who currently reside in Canada?

If yes, please indicate relationship:

Education

Please check any of the following statements which apply to you and, where applicable:

I have not completed secondary/high school.

I have completed a secondary school educational credential.
I have completed secondary/high school, but have completed a one-year diploma, trade certificate of apprenticeship AND have a total of 12 years full-time or full-time equivalent studies.
I have completed a one-year diploma, trade certificate or apprenticeship AND have a total of 13 years full-time or full-time equivalent studies.
I have completed a two-year diploma, trade certificate or apprenticeship AND have a total of 14 years full-time or full-time equivalent studies.
I have completed a three-year diploma, trade certificate or apprenticeship AND have a total of 15 years full-time or full-time equivalent studies.
I have completed a one-year university degree at the Bachelor’s level AND have a total of 13 years of full-time or full-time equivalent studies.
I have completed a two-year university degree at the Bachelor’s level AND have a total of 14 years of full-time or full-time equivalent studies.
I have completed two or more university degrees at the Bachelor’s level AND have a total of 15 years of full-time or full-time equivalent studies.
I have completed a PhD, or Master’s AND have a total of 17 years full-time or full-time equivalent studies.

Please provide following information about all your educational & training backgrounds:

Certificate / Field of study / Started in: (month - year) / Ended in: (month - year) / Full time or Part time / Institution / City, Country
1
2
3
4

Experiences and Jobs

Please provide the details of your professional work history for the last ten years only.

Title / Employer / Joined in: (month - year) / Left in: (month - year) / Hours per week on average / Main Duties / City, Country
Present Job
Previous Job
Previous Job
Previous Job

Please provide any additional working experience and or personal remarks:

Do you have arranged employment in Canada which has been validated by a Human Resource Development Canada office through an application made by your prospective employer?

Language Abilities

Please indicate your proficiency in both the English and French languages:

High:You can communicate effectively in most social and work situations.

Moderate:You can communicate comfortably in familiar social and work situations.

Basic:You can communicate in predictable contexts and on familiar topics, but with some difficulty

English / High Proficiency / Moderate Proficiency / Basic Proficiency / Not At All
Speak / / / /
Read / / / /
Write / / / /
Listen / / / /
French / High Proficiency / Moderate Proficiency / Basic Proficiency / Not At All
Speak / / / /
Read / / / /
Write / / / /
Listen / / / /

Assets

(1) Please provide an estimate of the total value of assets which you currently hold: (Canadian $)
(2) Please provide an estimate of the value of the funds which you anticipate being able to transfer to Canada upon your relocation: (Canadian $)

Previous Work/Study in Canada

(1) Myself or my spouse (if applicable) has previously held a valid Canadian employment authorization and did engage in at least one year of full-time employment in Canada: Yes No

(2) Myself or my spouse (if applicable) has previously held a valid Canadian student authorization and, after the age of seventeen, completed a two-year program of full-time study at a post-secondary institution in Canada. Yes No

Other

(1) Do you or any other member of your family have:
(a) Any past or present medical conditions: No Yes (if Yes, please explain):

(b) Any past criminal history in Canada or any other country: No Yes (if Yes, please explain)

(2) How were you referred to us?

Signature: