Assessment Form for Immigration to Canada Personal information First Name: Last Name: E-mail: Phone: Age: Country of residence: —Выберите вариант—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Marital status: SingleMarriedWidowedCommon-Law Do you have dependent children and if yes how many?: Knowledge of Canadian Official Languages Have you taken the English language exam in the last 2 years? YesNo What language exam did you take? IELTS GeneralCELPIP-G What score did you get? Listening —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 Reading —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 Writing —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 Speaking —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 What score did you get? Listening —Выберите вариант—less than 55678910-12 Reading —Выберите вариант—less than 55678910-12 Writing —Выберите вариант—less than 55678910-12 Speaking —Выберите вариант—less than 55678910-12 Have you taken the French language exam in the last 2 years? YesNo What language exam did you take? TEF CanadaTCF Canada What score did you get? Listening —Выберите вариант—145-180181-216217-248249-279280-297298+ Reading —Выберите вариант—121-150151-180181-206207-232233-247248+ Writing —Выберите вариант—349-370310-348271-309226-270181-225371+ Speaking —Выберите вариант—181-225226-270271-309310-348349-370371+ What score did you get? Listening —Выберите вариант—331-368369-397398-457458-502503-522523-548549-699 Reading —Выберите вариант—342-374375-405406-452453-498499-523524-548549-699 Writing —Выберите вариант—4-567-910-1112-1314-1516-20 Speaking —Выберите вариант—4-567-910-1112-1314-1516-20 What is your level of English? Listening —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Reading —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Writing —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Speaking —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency What is your level of French? Listening —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Reading —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Writing —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Speaking —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Education What is your level of education? (List all your education history) Did you get this education in Canada? High SchoolOne-year Post-secondary ProgramTwo-years Post-secondary ProgramBachelor's DegreeMaster's DegreePh.D. YesNo -+ Work experience What is your profession / primary occupation? How many years of skilled work experience do you have? -+ Do you have Canadian Work ExperienceYesNo What is your profession / primary occupation? How many years of Canadian work experience do you have? -+ Have you received a written job offer from a Canadian employer? YesNo Occupation Province —Выберите вариант—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukonNunavutNorthwest Territories Duration of your contract —Выберите вариант—Less Than 6 Months6 months1 year or longer How many hours per week you will work? Is your job offer supported by a Labour Market Impact Assessment (LMIA)? YesNo Other Personal Information Family in Canada Do you or your spouse/common-law partner have any family members or relatives (parents and siblings only) living in Canada? YesNo Your personal Net Worth Choose currency Canadian DollarsUS DollarsEuro Amount 10.000-15.00015.000-20.00020.000-25.00025.000-50.00050.000-100.000100.000-250.000250.000-500.000 Spouse/Common-law Partner Information What is the highest level of education of your Spouse/Common-Law Partner? —Выберите вариант—High SchoolOne-year Post-secondary ProgramTwo-years Post-secondary ProgramBachelor's DegreeMaster's DegreePh.D. How many years of CANADIAN work experience does your Spouse/Common-Law Partner have within the last ten years? Has your spouse taken the English language exam in the last 2 years? YesNo What language exam did he/she take? IELTS GeneralCELPIP-G What score did he/she get? Listening —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 Reading —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 Writing —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 Speaking —Выберите вариант—4.04.55.05.56.06.57.07.58.08.59.0 What score did he/she get? Listening —Выберите вариант—less than 55678910-12 Reading —Выберите вариант—less than 55678910-12 Writing —Выберите вариант—less than 55678910-12 Speaking —Выберите вариант—less than 55678910-12 Has your spouse taken the French language exam in the last 2 years? YesNo What language exam did he/she take? TEF CanadaTCF Canada What score did he/she get? Listening —Выберите вариант—145-180181-216217-248249-279280-297298+ Reading —Выберите вариант—121-150151-180181-206207-232233-247248+ Writing —Выберите вариант—349-370310-348271-309226-270181-225371+ Speaking —Выберите вариант—181-225226-270271-309310-348349-370371+ What score did he/she get? Listening —Выберите вариант—331-368369-397398-457458-502503-522523-548549-699 Reading —Выберите вариант—342-374375-405406-452453-498499-523524-548549-699 Writing —Выберите вариант—4-567-910-1112-1314-1516-20 Speaking —Выберите вариант—4-567-910-1112-1314-1516-20 What is your spouse's level of English? Listening —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Reading —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Writing —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Speaking —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency What is your spouse's level of French? Listening —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Reading —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Writing —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Speaking —Выберите вариант—None at allElementaryIntermediateAdvancedProficiency Additional information Please provide any additional information that you think would be relevant to your immigration assessment. At what stage of decision making are you? —Выберите вариант—Ready to start my applicationJust gathering information When do you plan to start your application? —Выберите вариант—ImmediatelyIn the next 3 monthsIn 6-12 monthsI'm not planning yet What is the best way to approach you? EmailSkypeWhatsAppViberPhone call I give permission to share my personal information with Canadian immigration companies.
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