Eligibility Assessment Form for Immigration to Canada

Immigration Eligibility Assessment Form
The personal information you provide to us is secure and is collected with the sole purpose of assessing your potential for immigration to Canada under the current Canadian immigration selection criteria. We will only respond to you in regard to your Canada Immigration evaluation. You may consult our Privacy Policy for complete details. Required fields are marked with an asterisk (*).

Personal Information
Title  *
Last Name  *
Given Name(s)  *
Gender  *
Status  *
Citizenship  *
Birthdate (mm/dd/yyyy)  *
E-mail Address  *
Phone Number  *
Home Address  *
Educational Qualification  *
Years of Further Studies after High School  *
Years of Full-Time Study  *
Work Experience / Business Experience
Profession / Nature of the Business
Job Position
Total number of years in the Profession / Business:
If you are an owner of a business OR woking in a managerial level in a business.
Total number of full time staff currently working directly under you
If corporation, percentage of your share holding in the company
Percentage of your spouse’s share holding in the company
Estimated annual sales of the company or business
in Canadian Dollars
Estimated annual Net Income of the company or business
in Canadian Dollars
Your personal total (without your spouse) net worth
in Canadian Dollars
Net worth means everything you own, such as properties, business, cash in the bank, stock and shares etc.
Language Proficiency
Proficiency in English  
Speaking  *
IELTS Test Score  *
Writing  *
Reading  *
Listening  *
Proficiency in French  
TEF Test Score
Spouse Details (If Married)
Last Name
First Name
Birthdate (mm/dd/yyyy)
Educational Qualification
Years of Full-Time Study
Years of Professional Practice
Proficiency in English  
Proficiency in French  
Dependent children under the age of 19
  Name of Dependants Indicate Age Indicate if Son or Daughter
Do you or your spouse have any blood relatives in Canada?  *
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