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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.

    Indicate with an “X” your highest level of education – Select ONE of the following TEN descriptions.
     

     

    (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.

    FIRST Canadian Official Language                Indicate:  
    A B C D
    READ WRITE SPEAK LISTEN
           

     

    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.

    SECOND Canadian Official Language                Indicate:  
    A B C D
    READ WRITE SPEAK LISTEN
           

     

    Part 4 – Employment

    Have passed or plan to write any Canadian/US/UK/Australian or New Zealand licensing exam?  
    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?  
    If you answered ‘yes’ to the previous question, please provide the following additional information.
    2. Have you been offered temporary or permanent employment?  
    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.
     

     

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

     

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

     

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

     

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

     

    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)
      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:

    1 … been in Canada, the US, the UK, Australia or New Zealand?  
    2 ... had relatives, friends, acquaintances or sponsor [employer]  in Canada, the US, the UK, Australia or New Zealand?  
    3 … been convicted of, or are currently charged with, on trial for, or party to a crime or offence, or subject to any criminal proceedings in any country?  
    4 … been detained or imprisoned anywhere for any period of time?  
    5 … made previous claims for refugee protection in any country or with the United Nations High Commission for Refugees (UNHCR)?  
    6 … been refused refugee status, a permanent or temporary resident visa, study or work permit for any country?  
    7 … been refused admission to, or ordered to leave, any country?  
    8 … served in the regular military of any country?  
    9 … served in the police, security service or judiciary of any country?  
    10 … passed or plan to take any Canadian/US/UK/Australian or New Zealand licensing exam?  
    11 … had any serious disease or physical or mental disorder?  
    If you have answered ‘yes’ to any of the above questions, please provide the details below, including places and dates. Attach an additional page if necessary.
     

     

    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?  
    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.  
    If your answer to question 1 is “yes”, then please provide the following information:  
    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?  
    What percentage of the equity of the business do/did you control or own?   %
    Percentage of equity means

    1. for a sole proprietorship, you or your spouse or common-law partner must control 100 per cent of the equity;
    2. 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;
    3. 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?  
    How may full-time employees work/worked for the business?   full-time employees
    Provide other details, if necessary.
     

     

    Part 10 – Finances

    Which of the following best describes your personal net worth (in Canadian dollars)?

     

    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.

     
    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?
     
    If you answered yes to the preceding question, what amount are you prepared to invest?   $

     

    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?  
    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   

     

     

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