Assessment questionnaire Canada

Please note:

English Language Test Result is an essential part of your Assessment application. You have to prove that you have achieved a score of at least 6.0 in each of the four test components (speaking, reading, listening and writing) in an International English Language Testing System (IELTS) test that has been undertaken in the two years immediately prior to lodging the visa application.

Please provide us with the details of your IELTS results (your score in each of the 4 test components; date and Reference Number of your Certificate), otherwise we will not be able to assess your case.

Part 1 – Identification

Please provide the following information before starting the assessment:

Your name:
Address:
Home tel
Work tel
Mobile tel
Fax
E-mail
Date of birth
No. of children
Children ages

Part 2 – Education

(a) Total years and type of diploma, etc.

(b) Education – History, place, etc.

Please provide the following information about your education.

From Month/Year	To Month/Year	Name of institution	City and country	Name of diploma	Specialization and occupation

Part 3 – English and French language ability

To assess your English and French ability, first decide the language with which you are most comfortable. This language is your first official language for the purposes of immigration to Canada.

The language with which you feel less comfortable communicating is your second official language for the purposes of immigration to Canada.

Mark the ONE box in each of COLUMNS A, B, C, and D that best indicates your ability to read, write, listen to and speak English AND / OR French.

Check ONE box in each of COLUMNS A, B, C, and D that best indicates your ability to read, write, listen to and speak the OTHER official language.

Part 4 – Employment

Have passed or plan to write any Canadian/US/UK/Australian or New Zealand licensing exam?

YesNo

If you answered ‘yes’ to the previous question, please provide details (type of license, place and date):

Please provide the following information about your employment history since 18 years of age (for example, apprenticeship, work, military service, unemployment, etc.).

For assessment purposes it would be helpful if you could also provide the number of your occupation(s) according to Canada’s *National Occupational Classification, which can be found by entering your job title in the “Quick Search” box at http://www5.hrsdc.gc.ca/NOC/English/NOC/2011/Welcome.aspx

From Month/Year	To Month/Year	Name of employer	City and country	Occupation	* National Occupational Classification

Part 5 – Employment in Canada

1.	Do you have arranged employment (a job offer) in Canada?	YesNo
If you answered ‘yes’ to the previous question, please provide the following additional information.
2.	Have you been offered temporary or permanent employment?	TemporaryPermanent
3.	If you have been offered temporary employment, for what period of time has it been offered to you.	months
4.	In what occupation (or job title) have you been offered employment?
5.	If you know Canada’s National Occupational Classification number for that job, then please provide it. (NOC No.)
6.	Please provide the city and province where you have been offered employment.

Part 6 – Family Adaptability

The following FIVE sub-factors are taken into consideration in assessing your adaptability for immigrating to Canada.

Indicate with an “X” the highest level of education of your spouse or common-law partner. Select ONE of the following EIGHT descriptions.

(1) Secondary school diploma or less(2) A one-year diploma, trade certificate or apprenticeship and completed at least 12 years of full-time or full-time equivalent studies(3) A one-year diploma, trade certificate or apprenticeship or university degree at the bachelor’s level and completed at least 13 years of full-time or full-time equivalent studies(4) A two-year diploma, trade certificate or apprenticeship or university degree at the bachelor’s level and completed at least 14 years of full-time or full-time equivalent studies(5) A three-year diploma, trade certificate or apprenticeship (not university) and completed at least 15 years of full-time or full-time equivalent studies(6) Two or more university degrees at the bachelor’s level and completed at least 15 years of full-time or full-time equivalent studies(7) A master’s or Ph.D. and completed at least 17 years of full-time or full-time equivalent studies(8) Not applicable

Have either you or your spouse / common-law partner ever studied in Canada? Check ONE of the following TWO situations:

(1) No, or has less than two years post-secondary education in Canada(2) Completed at least two years of post-secondary education in Canada since the age of 17

Have either you or your spouse / common-law partner ever worked in Canada? Check ONE of the following TWO situations:

(1) No, or have worked full-time in Canada for less than one year(2) Worked full-time in Canada for at least one year

Do you have arranged employment (job offer) in Canada?

Check this box if you have arranged employment in Canada under Section 5 above

Do either you or your spouse / common-law partner have family in Canada. Check ONE of the following TWO situations.

(1) No family in Canada(2) Family in Canada (parent, grandparent, aunt, uncle, sister, brother, niece, nephew, child or grandchild, spouse or common-law partner who is a Canadian citizen or permanent resident living in Canada)

Part 7 – Settlement Funds

Will you have the necessary funds required for settling in Canada for the size of a family like yours, given the following minimum requirements?	*Number of Family Members*	*Funds Required* *(Canadian dollars) (2014–04–03)*
YesNo	1	$11,824
	2	$14,720
	3	$18,097
	4	$21,971
	5	$24,920
	6	$28,105
	7 or more	$31,291

Part 8 - Security

Have you or any of your family members (spouse and children) ever:

The following 2 sections are for business immigrants only (investors, entrepreneurs and self-employed persons).

Part 9 – Business and/or Management Experience

(1) Management experience

Have you had experience in managing the operation of a business enterprise or government agency during the past 5 years?		YesNo
If the answer to Question 1 is yes and there was more than one business or government agency, then please provide the following information:
The name of the most recent or the largest business enterprise or government agency:
In what type of activity is/was the business enterprise or government agency engaged:
Your job title or position:
City or region:
Country:
Duration of management period	years	months
Hours per week of management activity	hours
The number of years during the past 5 years during which you managed at least 5 full-time workers	years	months
Your employment duties:	years	months

(2) Ownership and/or control

Have you owned or controlled at least part of business over the past 5 years.	YesNo
If your answer to question 1 is “yes”, then please provide the following information:	YesNo
What was the name of the most recent or the largest business?
In what type of activity is/was the business engaged?
Is/was the business operated primarily for the purposes of earning investment income?	YesNo
What percentage of the equity of the business do/did you control or own?	%
Percentage of equity means for a sole proprietorship, you or your spouse or common-law partner must control 100 per cent of the equity; for a corporation, this is the percentage of the issued and outstanding voting shares of the capital stock of the corporation that is controlled by you or your spouse or common-law partner; for a partnership or joint venture, this is the percentage of the profit or loss of the enterprise to which you or your spouse or common-law partner is entitled.
For how many of the past 6years have/did you control or own such a percentage?	years
Have the gross sales for at least 2 of the past 5 years exceeed $500,000 CAD?	YesNo
How may full-time employees work/worked for the business?	full-time employees
Provide other details, if necessary.

Part 10 – Finances

The following section is for Investors and Entrepreneurs only.

Part 11 – BUSINESS TRIPS TO CANADA

Have you made a business exploration trip to Canada in the past 5 years that is supported by documentation confirming that you have met the immigration requirements of a Canadian provincial government?	YesNo
Have you participated in a joint federal-business immigration initiative that is supported by documentation confirming that you have met the immigration requirements of a Canadian provincial government	YesNo

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FIRST Canadian Official Language Indicate:
A	B	C	D
READ	WRITE	SPEAK	LISTEN
High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency	High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency	High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency	High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency

SECOND Canadian Official Language Indicate:
A	B	C	D
READ	WRITE	SPEAK	LISTEN
High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency	High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency	High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency	High ProficiencyModerate ProficiencyBasic ProficiencyNo Proficiency

Which of the following best describes your *personal net worth* (in Canadian dollars)?	Under $50,000Under $100,000Under $200,000Under $300,000From $301,000 to $500.000From $501,000 to $800,000From $801,000 to $1,200,000From $1,200,001 to $1,600,000Over $1,600,000
NOTE: In this context, “*personal net worth*” is the difference between the fair market value of all of your and your spouse’s (common-law or same-sex partner’s) assets and all of the debts and liabilities.
Please explain how you accumulated your net worth (inheritance, investment, business, etc.)

Are you prepared to invest $1,600,000 CAD, payable to the Receiver General of Canada or the Government of the Province of Quebec, in the form of a 5-year loan, repayable without interest, with repayment guaranteed without interest by a participating Canadian provincial government? NOTE: In this context, investment is ‘passive’, i.e., it does not require or otherwise involve the ‘active’ management of an enterprise.
YesNo
Are you prepared to invest between $150,000 and $ 800,000 CAD in a Canadian business and involve yourself in the active, day-to-day management of that business?
YesNo
If you answered yes to the preceding question, what amount are you prepared to invest?	$