ONLINE ASSESMENT

PERSONAL DETAILS :

1. Family/Last Name (exactly as shown on your passport or travel document) :

2. Given/First Name(s) (exactly as shown on your passport or travel document) :

3. If you ever used any other name (e.g. Nickname, maiden name, alias, etc) please provide:

Family/Last name(s)

Given/First name(s)

5. Sex

Height (cm or ft. in)

Eye Color:

6. Date of Birth (yyyy-mm-dd)

7. City of Birth City :

Country :

8. Country of Citizenship

9. Current country of residence:

Status (i.e. citizen/worker/visitor)

From (mm-dd-yyyy)

To (mm-dd-yyyy)

10. Current Residential Address

P.O. box

Apt./Unit

Street No.

Street name

City/Town

Country

Province/State

Postal Code

District

Primary Telephone number (Canada/US or Other)

E-mail address

Primary Telephone number (Canada/US or Other)

PASSPORT:

11. Do you have a valid passport/travel document?

If yes, please give the document number (exactly as shown on your passport or travel document)

Country of issue

Issue date (yyyy-mm-dd)

Expiry date (yyyy-mm-dd)

Attach a scanned copy with this form

NATIONAL IDENTITY DOCUMENT:

12. Do you have a national identity document?

Document number

Country of issue

Issue date (yyyy-mm-dd)

Expiry date (yyyy-mm-dd)

13. Have you ever applied for biometrics for an application to come to Canada?

LANGUAGE SKILLS:

Exams:

Yes No

14. Have you appeared for IELTS/ CELPIP or any English/French Testing

Exam	Speaking	Listening	Reading	Writing	Overall

Attach a score card with this form

EDUCATIONAL DETAILS:

15. Give full details of all the secondary and post-secondary education (including university, college and apprenticeship training) you have had.

From(yyyy/mm)	To (yyyy/mm)	Name of institution	City and country	Type of Certificate or Degree Issued	Field of Study

Add

Educational Credential Assessment (WES/EQAS etc) completed: Yes/No,if yes, attach the report with this form

Result of the Educational Credential Assessment:

WORK EXPERIENCE

16. Provide a history of all the work experience you have gained

From (yyyy/mm)	To (yyyy/mm)	Name of company	Position	Job duties in detail	Address

Add

ADDRESS HISTORY

17. Provide all of the addresses where you have lived in the past 10 years or since your 18th birthday

From (yyyy/mm)	To (yyyy/mm)	Address

Add

21. Personal details of your father

Family/Last name (s)

Given/First name(s)

Date of birth (yyyy-mm-dd)

Town/City& Country of birth

Current Residential Address:

Date of death, if deceased (yyyy-mm-dd)

Place of death, if deceased

22. Personal details of your mother

Family/Last name (s)

Given/First name(s)

Date of birth (yyyy-mm-dd)

Town/City& Country of birth

Current Residential Address:

Date of death, if deceased (yyyy-mm-dd)

Place of death, if deceased

PERSONAL DETAILS :

PASSPORT:

NATIONAL IDENTITY DOCUMENT:

LANGUAGE SKILLS:

EDUCATIONAL DETAILS:

WORK EXPERIENCE

ADDRESS HISTORY

21. Personal details of your father

22. Personal details of your mother

BACKGROUND/DECLARATION :

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