Skilled Workers Canada

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Canada Immigration Assessment

To request our assessment of your potential for immigration to Canada , please complete the information below and click "Submit". We charge a non-refundable fee of $100 to assess your potential for Canadian Immigration. If based on your assessment, you choose to proceed with your Canadian immigration application, this $100 will be applied towards your application preparation fees. However, if you do not proceed with your application, then this fee will still be non-refundable.

Upon submitting this form, you will be transferred to a page where you can pay your assessment fee using a credit card or Paypal. If you do not have a credit card or a Paypal account, then please contact us at: + 1-604-708-4694, + 234-1-2710938, + 234-8034985318, + 234-8080992904 or via email (immigrate@skilledworkerscanada.com) for details on alternative methods of payment.

Personal and Family Information

PRINCIPAL APPLICANT

Title:

*Surname:

*Previous Surname (if applicable):

*First name:

*Middle Name:

*Address:

*Date of Birth:

*Place of Birth:

*Present Nationality:

*Nationality at birth:

*Preferred Tel. No.:

*Preferred time of contact:

*Mobile No.:

*Marital Status:

*Years of marriage (if applicable):

*Any serious illness or disability:

*Details of any Criminal Conviction:

SPOUSE/PARTNER

Title:

Surname:*

Previous Surname (if applicable):

First name:*

Middle Name:

Address:

Date of Birth:

Place of Birth:

Present Nationality:

Nationality at birth:

Preferred Tel. No.:

Preferred time of contact:

Mobile No.:

Marital Status:

Years of marriage (if applicable):

Any serious illness or disability:

Details of any Criminal Conviction:

CHILDREN

Please list all your children and that of your spouse. Please do so whether or not they will be accompanying you abroad and even if they are aged 18years or over.

Name

Sex

Date/Place of Birth

Nationality

Accompanying you?

Add child

Any serious illness or disability:

Details of any Criminal Conviction:

FAMILY LIVING IN CANADA

Name

Relationship

Country of Residence

Status

Add person

Educational and Professional Training

Please give as much detail as possible on all courses, certificates and training. Please also state whether your studies were part time or full time, in service training etc. You may continue on another sheet if necessary.

PRINCIPAL APPLICANT:

Please indicate the total number of years of education you have (from primary school till date):

Educational Institution

Courses Taken

From

Part Time/Full Time

Add training

Professional Memberships:

Languages Spoken:

English

French

English

High

Moderate

Basic

None

French

High

Moderate

Basic

None

SPOUSE/PARTNER:

Please indicate the total number of years of education you have (from primary school till date):

Educational Institution

Courses Taken

From

Part Time/Full Time

Add training

Professional Memberships:

Languages Spoken:

English

French

English

High

Moderate

Basic

None

French

High

Moderate

Basic

None

Employment History

PRINCIPAL APPLICANT:

1.	Name of Employer:
	Employer’s line of business:
	Period of Employment:	From	To
	Job Title:
	Job Duties and Responsibilities:


2.	Name of Employer:
	Employer’s line of business:
	Period of Employment:	From	To
	Job Title:
	Job Duties and Responsibilities:


3.	Name of Employer:
	Employer’s line of business:
	Period of Employment:	From	To
	Job Title:
	Job Duties and Responsibilities:

Please review the list of priority occupations at: http://www.cic.gc.ca/english/immigrate/skilled/apply-who-instructions.asp
Do you have at least 1 year of experience (within the last 10 years) in any occupation(s) that fall within priority occupations in Canada? If so, please identify the relevant occupation (s).

Your answer:

SPOUSE/PARTNER:

1.	Name of Employer:
	Employer’s line of business:
	Period of Employment:	From	To
	Job Title:
	Job Duties and Responsibilities:


2.	Name of Employer:
	Employer’s line of business:
	Period of Employment:	From	To
	Job Title:
	Job Duties and Responsibilities:


3.	Name of Employer:
	Employer’s line of business:
	Period of Employment:	From	To
	Job Title:
	Job Duties and Responsibilities:

Your answer:

Travel Information

Which Province would you like to go to in Canada?

Do you know which immigration program you would like to pursue?

When would you like to leave for Canada?

Please indicate your specific reasons/motivation for wishing to move to Canada.

Financial Information

Please provide as close an estimate as possible of your assets and liabilities in Canadian Dollars or your local currency.

Assets

Liabilities

Main Property
Second Property
Investments
Motor Vehicles/Bikes
Cash/Savings
Other


TOTAL

Monthly income:

Monthly Outgoings:

How much are you prepared to invest in your visa application?

Do you have an offer of arranged employment in Canada

Would you consider making an investment in Canada or establishing or buying a business there?

Would you be willing to live in Canada to manage the business?

Marketing Information

Please assist us by providing the following information.

Where did you hear about us:

If on the internet, which site/search engine:

Which radio station do you listen to:

Which Sunday/Daily National newspaper do you regularly read:

Which regional newspaper do you regularly read:

Do you have internet access?

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