Assessment Form

This form is for our own use only. In order to succeed in obtaining a temporary or permanent resident permit for Canada, it is important to answer all questions fully and truthfully. Information collected will be strictly kept confidential, and will not be used in mailing lists.



Language Ability:

English : French :


years years

Employment History:

  Period Position Job Duties


Personal Financial Information:

Personal Net Worth (US$)

Business Financial Information (US$)

Other Important Information:

Contact person in Canada or U.S.

Do you or your spouse have relatives in Canada?


Have you or your spouse studied or worked in Canada?

If yes,

Can you or your spouse secure a job offer from a Canadian Employer?


Have you or any of your dependants ever:

1. Had any serious disease or mental disorder?�  
2. Been convicted or are currently charged with any crime or offence in any country?  
3. Applied previously for an immigrant visa to Canada?  
4. Been refused an immigrant visa to Canada or any other country?  
5. Been refused admission or ordered to leave Canada or any other country?  

I hereby certify that all of the information I have provided above is true.