Canada Preliminary Assessment Form

Personal/Contact Information

First Name
Middle Name
Last Name
Sex
Male Female
Date of Birth
Country of citizenship
Marital Status

Contact

Current Mailing Address - House/ Street Number
Current Mailing Address (Continued)
City / Town
Province / State
Country of residence
Postal / ZIP Code
Telephone Country Code
Telephone City Code
Home Telephone number
Alternate Telephone number
Email address
Alternative email address (If any)

Education

Highest Level of College/University Education Achieved


IELTS

IELTS Taken


if yes please specify the scores

Listening  Reading
Writing     Speaking

Language Proficiency

Choice of First Language


Proficiency in Language 1
Read     Write
Speak Listen

Proficiency in Language 2
Read     Write
Speak Listen

Employment

Total years of full time Employment
Current Occupation

Ties with Canada

Do you have arranged Employment in Canada?
Have you ever studied in Canada?
Have you ever worked in Canada?
Do you have close relatives in Canada?
Is your relative your

Details of Spouse / Common-law Partner

Education

Highest Level of College/University Education Achieved

Ties with Canada

Does your spouse have arranged Employment in Canada?
Has your spouse ever studied in Canada?
Has your spouse ever worked in Canada?
Does your spouse have close relatives in Canada?
The relation is your spouse's

Details of Children

Total number of Children below 22 years of Age


Total number of Children above 22 years of Age