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Please complete a separate questionnaire for each
person
over the age of 18 years. |
| Who Referred You: |
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| Your Surname: |
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| First Name: |
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| Email Address: |
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| Full Mailing Address: |
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| Country: |
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| Phone Number: |
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| Fax Number: |
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| Cell Phone Number: |
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| Sex: |
Male Female |
| Date of Birth: |
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| Age: |
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Marital Status:
* if married your spouse must also complete the questionnaire * |
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| Spouse's Full Name: |
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Children's Name, Age & Sex: |
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Education: Please list the names and dates of all schools, colleges and universities attended, and what degree, diploma or certificate was granted. |
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Languages: Indicate your ability to speak, read and write, and whether fluently, well, little or not at all: |
| English: |
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| French: |
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| Mother Tongue: |
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| Other: |
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What is your destination in Canada? |
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| Do you have a job offer? |
Yes No |
If yes, give details:
* including name and address of person offering you the job and the
type of work you will be doing * |
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Do you have relatives in Canada? |
Yes No |
| If yes, what is the relationship? |
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Do any of your relatives own a business in Canada? |
Yes No |
| If yes, please give full details: |
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Will your relatives assist you financially, if necessary? |
Yes No |
Have you or your spouse or children ever had medical problems? |
Yes No |
| If yes, give full details: |
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Do you or your spouse or children have a criminal record? |
Yes No |
| If yes, give full details: |
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Have you or your spouse or children ever been denied entry into any country? |
Yes No |
| If yes, give full details: |
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How much money do you have (in US dollars): |
| Liquid Funds: |
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| Real Estate: |
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| Other: |
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What is your present income? |
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| What are your total debts? |
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Work Experience: Provide as much detail as possible, including years of experience, job title and responsibilities. |
Current occupation:
(Date commenced) |
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All previous occupations:
(How long in each) |
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Have you ever owned your own business? |
Yes No |
| If yes, give details e.g. what percentage of the business, duties, etc. |
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Do you think you would be able to obtain travel documents to visit: |
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| USA |
Yes No |
| EUROPE |
Yes No |
