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General Immigrant Evaluation
Personal Information
Family name
*
First name
*
Address
City/State
Country
*
--select one--
Afghanistan
Albania, People's Socialist Republic of
Algeria, People's Democratic Republic of
American Samoa
Andorra, Principality of
Angola, Republic of
Anguilla
Antarctica (the territory South of 60 deg S)
Antigua and Barbuda
Argentina, Argentine Republic
Armenia
Aruba
Australia, Commonwealth of
Austria, Republic of
Azerbaijan, Republic of
Bahamas, Commonwealth of the
Bahrain, Kingdom of
Bangladesh, People's Republic of
Barbados
Belarus
Belgium, Kingdom of
Belize
Benin, People's Republic of
Bermuda
Bhutan, Kingdom of
Bolivia, Republic of
Bosnia and Herzegovina
Botswana, Republic of
Bouvet Island (Bouvetoya)
Brazil, Federative Republic of
British Indian Ocean Territory (Chagos Archipelago)
British Virgin Islands
Brunei Darussalam
Bulgaria, People's Republic of
Burkina Faso
Burundi, Republic of
Cambodia, Kingdom of
Cameroon, United Republic of
Canada
Cape Verde, Republic of
Cayman Islands
Central African Republic
Chad, Republic of
Chile, Republic of
China, People's Republic of
Christmas Island
Cocos (Keeling) Islands
Colombia, Republic of
Comoros, Union of the
Congo, Democratic Republic of
Congo, People's Republic of
Cook Islands
Costa Rica, Republic of
Cote D'Ivoire, Ivory Coast, Republic of the
Cuba, Republic of
Cyprus, Republic of
Czech Republic
Denmark, Kingdom of
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
Ecuador, Republic of
Egypt, Arab Republic of
El Salvador, Republic of
Equatorial Guinea, Republic of
Eritrea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands (Malvinas)
Fiji, Republic of the Fiji Islands
Finland, Republic of
France, French Republic
French Guiana
French Polynesia
French Southern Territories
Gabon, Gabonese Republic
Gambia, Republic of the
Georgia
Germany
Ghana, Republic of
Gibraltar
Greece, Hellenic Republic
Greenland
Grenada
Haiti, Republic of
Guadaloupe
Guam
Guatemala, Republic of
Guinea, Revolutionary People's Rep'c of
Guinea-Bissau, Republic of
Guyana, Republic of
Haiti, Republic of
Heard and McDonald Islands
Holy See (Vatican City State)
Honduras, Republic of
Hong Kong, Special Administrative Region of China
Hrvatska (Croatia)
Hungary, Hungarian People's Republic
Iceland, Republic of
India, Republic of
Indonesia, Republic of
Iran, Islamic Republic of
Iraq, Republic of
Ireland
Israel, State of
Italy, Italian Republic
Jamaica
Japan
Jordan, Hashemite Kingdom of
Kazakhstan, Republic of
Kenya, Republic of
Kiribati, Republic of
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait, State of
Kyrgyz Republic
Lao People's Democratic Republic
Latvia
Lebanon, Lebanese Republic
Lesotho, Kingdom of
Liberia, Republic of
Libyan Arab Jamahiriya
Liechtenstein, Principality of
Lithuania
Luxembourg, Grand Duchy of
Macao, Special Administrative Region of China
Macedonia, the former Yugoslav Republic of
Madagascar, Republic of
Malawi, Republic of
Malaysia
Maldives, Republic of
Mali, Republic of
Malta, Republic of
Marshall Islands
Martinique
Mauritania, Islamic Republic of
Mauritius
Mayotte
Mexico, United Mexican States
Micronesia, Federated States of
Moldova, Republic of
Monaco, Principality of
Mongolia, Mongolian People's Republic
Montserrat
Morocco, Kingdom of
Mozambique, People's Republic of
Myanmar
Namibia
Nauru, Republic of
Nepal, Kingdom of
Netherlands Antilles
Netherlands, Kingdom of the
New Caledonia
New Zealand
Nicaragua, Republic of
Niger, Republic of the
Nigeria, Federal Republic of
Niue, Republic of
Norfolk Island
Northern Mariana Islands
Norway, Kingdom of
Oman, Sultanate of
Pakistan, Islamic Republic of
Palau
Palestinian Territory, Occupied
Panama, Republic of
Papua New Guinea
Paraguay, Republic of
Peru, Republic of
Philippines, Republic of the
Pitcairn Island
Poland, Polish People's Republic
Portugal, Portuguese Republic
Puerto Rico
Qatar, State of
Reunion
Romania, Socialist Republic of
Russian Federation
Rwanda, Rwandese Republic
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Samoa, Independent State of
San Marino, Republic of
Sao Tome and Principe, Democratic Republic of
Saudi Arabia, Kingdom of
Senegal, Republic of
Serbia and Montenegro
Seychelles, Republic of
Sierra Leone, Republic of
Singapore, Republic of
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia, Somali Republic
South Africa, Republic of
South Georgia and the South Sandwich Islands
Spain, Spanish State
Sri Lanka, Democratic Socialist Republic of
Sudan, Democratic Republic of the
Suriname, Republic of
Svalbard & Jan Mayen Islands
Swaziland, Kingdom of
Sweden, Kingdom of
Switzerland, Swiss Confederation
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand, Kingdom of
Timor-Leste, Democratic Republic of
Togo, Togolese Republic
Tokelau (Tokelau Islands)
Tonga, Kingdom of
Trinidad and Tobago, Republic of
Tunisia, Republic of
Turkey, Republic of
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Virgin Islands
Uganda, Republic of
Ukraine
United Arab Emirates
United Kingdom of Great Britain & N. Ireland
United States Minor Outlying Islands
United States of America
Uruguay, Eastern Republic of
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam, Socialist Republic of
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia, Republic of
Zimbabwe
Postal code
Phone number (area code)
*
Cell phone (area code)
E-mail address
*
Re-enter E-mail address
*
Date of Birth
*
/
/
(dd/mm/yyyy)
Gender
*
Male
Female
Education
Post Secondary Education (diploma, number of years, etc)
*
Total number of years of studies (starting from primary school)
Work experience
From:
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
To:
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Job Title:
Company Name:
Details:
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Knowledge of Languages
*
Writing
Reading
Speaking
Listening
English
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
French
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
Have you ever worked or studied in Canada?
*
-- select one --
yes
no
if yes, what for and for how long?
Do you have any family members that are Canadian Permanent Residents or Citizen?
*
-- select one --
yes
no
Specify if the relative is your father/mother, son/daughter, aunt/uncle, grandparents, brother/sister?
Do you have children?
*
-- select one --
yes
no
if yes, how many and what is the date of birth for each?
Do you have a spouse or common-law partner (living together for at least 1 year)?
*
-- select one --
yes
no
Spouse's Date of Birth
/
/
(dd/mm/yyyy)
Spouse's Education
Post Secondary Education (diploma, number of years, etc)
Total number of years of studies (starting from primary school)
Spouse's Work experience
From:
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
To:
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Job Title:
Company Name:
Details:
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
January
February
March
April
May
June
July
August
September
October
November
December
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Spouse's Knowledge of Languages
Writing
Reading
Speaking
Listening
English
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
French
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
-- Select --
Strong
Moderate
Basic
Not at All
Total Net Worth
Any Criminal Record?
-- select one --
yes
no
Any Medical Problems? (if yes, specify)
-- select one --
yes
no
Where did you hear from us?
--select one--
Afrique Expansion
Alliance Française
Filipino Forum
Filipino Star
Fraternite Matin
friend
google
icilome
Le Messenger
Les nouvelles Chinoises
Intelligent(Mag)
Intelligent(Web)
Pragati
Sino Quebec
voila
yahoo
other
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