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APPLICANT

1. First Name

2. Last Name

3. Gender

Male

Female

4. Date of birth

5. How many persons are you including on this application?

6. Please select you current Status in Canada

Visitor Record

Visitor Visa

Work Permit

Study Permit

Refugee status – decision not yet made

Permanent Resident in Canada

Permanent Resident outside Canada

Canadian Citizen inside Canada

Canadian Citizen outside Canada

7. How long have you been residing in Canada under this status?

8. What is the date of expiry of your current status in Canada (if applicable)?

9. Current Country of Residence:

10. Country of Citizenship

11. Email

12. Phone/Mobile

13. Residential address:

14. Mailing address:

15. Current marital status:

Never Married/single

Married

Separated

Divorced

Widowed

16. Do you have children from your current marriage?

Yes

No

17. Will any of your children accompany you to Canada?

Yes

No

18. How many children do you have from your current marriage?

19. What are the ages of your children?

20. Do you have any step children?

Yes

No

21. What are the ages of your step children from current marriage?

22. Were you previously married?

Yes

No

23. Did you sponsor your current spouse or common-law?

24. If you were previously married, have you sponsored your ex-spouse or ex-common law forPermanent Resident Visa to Canada or you were sponsored by your ex-spouse or ex-commonlaw?

Yes

No

25. How many children do you have from any previous marriages?

26. Did you take any language test before in the past two (2) years (IELTS, CELPIP, TEF, or TCF)?

Yes

No

If you answered ‘Yes’ to the question #26, Can you please provide us with your test results

Reading:

Writing:

Speaking:

Listening:

27. Do you have a job offer in Canada?

Yes

No

28. Please tell us more about your work experience for the past 10 years

Work experience #1

From

To

Job title

Type of employment

Full-time

Part-time

Contract

Casual

Employer name or Company name

Self-employed

Yes

No

City, Country

Work experience #2

From

To

Job title

Type of employment

Full-time

Part-time

Contract

Casual

Employer name or Company name

Self-employed

Yes

No

City, Country

Work experience #3

From

To

Job title

Type of employment

Full-time

Part-time

Contract

Casual

Employer name or Company name

Self-employed

Yes

No

City, Country

29. Have you completed a degree, diploma or certificate from a Canadian institute in Canada?

Yes

No

30. In general, what is your highest level of education?

Less than secondary school (high school)

Secondary diploma (high school graduation)

One-year degree, diploma or certificate from a university, college, trade or technical school, or other institute

Two-year program at a university, college, trade or technical school, or other institute

Bachelor's degree OR a three or more year program at a university, college, trade or technical school, or other institute Two ormore certificates, diplomas, or degrees. One must be for a program of three or more years.

Master's degree, OR professional degree needed to practice in a licensed profession (For “professional degree,” the degreeprogram must have been in: medicine, veterinary medicine, dentistry, optometry, law, chiropractic medicine, or pharmacy.)

Doctoral level university degree (Ph.D.)

31. What is your total years of education?

32. Have you obtained an ECA (Education Credential Assessment) report from an accreditedCanadian Institution?

Yes

No

If you answered ‘Yes’ to question 32, please provide your ECA report equivalency result?

33. Which provinces or territories would you consider living in?

Alberta

British Colombia

Manitoba

New Brunswick

Newfoundland and Labrador

Northwest Territories Nova

Scotia

Nunavut

Ontario

Prince Edward Island

Saskatchewan

Yukon

All provinces and Territories

34. Do you have any direct blood related family member (ex. Father, mother, brother, sister, son,daughter, grand parent or grandson/grand daughter, nephew or niece) in Canada who is aPermanent Resident or Canadian Citizen?

Yes

No

35. In which province or territory does your direct blood related family member reside in?

Alberta

British Colombia

Manitoba

New Brunswick

Newfoundland and Labrador

Northwest Territories Nova

Scotia

Nunavut

Ontario

Prince Edward Island

Saskatchewan

Yukon

All provinces and Territories

36. Do you have any friend in Canada who is a Permanent Resident or a Canadian Citizen?

Yes

No

37. In which province or territory does your friend in Canada who is a Permanent Resident or a Canadian Citizen reside in?

Alberta

British Colombia

Manitoba

New Brunswick

Newfoundland and Labrador

Northwest Territories Nova

Scotia

Nunavut

Ontario

Prince Edward Island

Saskatchewan

Yukon

All provinces and Territories

38. Do you have any application currently in processing with Immigration, Refugee and CitizenshipCanada or a Provincial or territorial nomination program (including having an active ExpressEntry profile)?

Yes

No

39. Have you previously applied to visit, study, work or immigrate to Canada?

Yes

No

40. Did you have any previous rejections on your previous applications (Federally or provincially) ?

Yes

No

41. Where you issued a removal order or stayed beyond your legal status in Canada?

Yes

No

42. Have you received a nomination certificate from a province or a territory in Canada?

Yes

No

43. Have you or any of your family members had Chronical Disease(s)?

Yes

No

44. Have you or any of your family members had Criminal Record(s)?

Yes

No

45. Approximately how much funds do you have for your settlement, visit or study in Canada?

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