ISA Immigration Services Agency Inc.

*Please note: All information submitted remains strictly confidential.

IMPORTANT: IF YOU ARE MARRIED OR LIVING COMMON LAW, YOUR SPOUSE/PARTNER MUST ALSO COMPLETE THE EVALUATION FORM.


PERSONAL INFORMATION

FAMILY NAME :

GIVEN NAMES :

MALE / FEMALE

DATE OF BIRTH :
/ / (day/month/year) ex: 25/01/1950

FULL MAILING ADDRESS:

E-MAIL :

SKYPE Name :

TELEPHONE  (PLEASE INCLUDE YOUR AREA CODE):

MOBILE / CELLULAIRE (PLEASE INCLUDE YOUR AREA CODE):

COUNTRY OF CITIZENSHIP :

PRESENTLY RESIDING IN (COUNTRY) :

MARITAL STATUS :

NUMBER OF CHILDREN 12 YEARS OF AGE AND UNDER:

NUMBER OF CHILDREN 13 TO 18 YEARS OF AGE:

NUMBER OF CHILDREN 19 YEARS OF AGE AND OLDER. :

DO YOU HAVE ANY FAMILY OR FRIENDS RESIDING IN CANADA WHO ARE EITHER CANADIAN CITIZENS OR PERMANENT RESIDENTS OF CANADA?
YES NO

IF YES, WHAT IS THE EXACT RELATIONSHIP (i.e., father, mother, brother, sister, uncle, aunt, niece, nephew, cousin, friend, etc), AND

IF YES, WHERE IN CANADA DO THEY LIVE?

HAVE YOU EVER VISITED CANADA?
YES NO

IF YES, THEN WHEN? FOR HOW LONG? AND UNDER WHAT STATUS (visitor, student, work permit)?

HAVE YOU PREVIOUSLY APPLIED FOR IMMIGRATION TO CANADA?
YES NO

IF YES, WHEN DID YOU APPLY, TO WHICH OFFICE AND WHAT HAPPENED?


LANGUAGE SKILLS :

ENGLISH:

SPEAK : 
WRITE : 
READ :   
COMPREHENSION :

FRENCH:

SPEAK : 
WRITE : 
READ :   
COMPREHENSION :


EDUCATION

INDICATE EACH LEVEL OF EDUCATION COMPLETED SUCCESSFULLY IN WHICH YOU EITHER RECEIVED A CERTIFICATE, DIPLOMA OR DEGREE:

PRIMARY, NUMBER OF YEARS: , FOR:

HAVE YOU PASSED SECONDARY (SC) WITH AT LEAST 4 CREDITS? YES NO

HIGHER SECONDARY (HSC), NUMBER OF YEARS: , FOR:

HAVE YOU PASSED HIGHER SECONDARY (HSC) WITH AT LEAST 2 MAIN SUBJECTS? YES NO

POLYTECHNIQUE, NUMBER OF YEARS: , FOR:

UNIVERSITY, NUMBER OF YEARS: , FOR:

POST GRADUATE, NUMBER OF YEARS: , FOR:

IF YOU ATTENDED COLLEGE OR UNIVERSITY, PLEASE INDICATE THE NAME OF THE SCHOOL:

IF YOU ATTENDED COLLEGE OR UNIVERSITY, PLEASE SPECIFY IN WHICH FIELD YOU RECEIVED YOUR DIPLOMA OR DEGREE:

IF YOU ATTENDED COLLEGE OR UNIVERSITY, PLEASE SPECIFY THE DATE WHEN YOU OBTAINED YOUR DIPLOMA OR DEGREE:

HAVE YOU SUCCESSFULLY TAKEN ANY OTHER COURSES SUCH AS TRADE, PROFESSIONAL, VOCATIONAL, OTHERS?
YES NO

IF YES, PLEASE GIVE DETAILS, INCLUDING LENGTH OF COURSE, CLASSROOM OR CORRESPONDENCE, AND WAS IT FULL-TIME OR PART-TIME? :


DETAILS OF YOUR WORK HISTORY FOR THE PAST TEN YEARS.

MOST RECENT EMPLOYMENT :

FROM: / (month/year) TO: / (month/year)

DETAILED JOB DESCRIPTION (DUTIES, RESPONSIBILITIES) : VERY IMPORTANT

1) PREVIOUS EMPLOYMENT :

FROM: / (month/year) TO: / (month/year)

DETAILED JOB DESCRIPTION (DUTIES, RESPONSIBILITIES) : VERY IMPORTANT

2) PREVIOUS EMPLOYMENT :

FROM: / (month/year) TO: / (month/year)

DETAILED JOB DESCRIPTION (DUTIES, RESPONSIBILITIES) : VERY IMPORTANT


HOW DID YOU HEAR ABOUT US?

PLEASE SPECIFY:

DO YOU HAVE ANY QUESTIONS OR COMMENTS?

IMPORTANT: IF YOU ARE MARRIED OR LIVING COMMON LAW, YOUR SPOUSE/PARTNER MUST ALSO COMPLETE THE EVALUATION FORM.