Wilson Immigration

Free Assessment

Part 1: Personal Information

Last Name / Family Name / Surname:

First Name / Given Name:

Middle Name:

Mailing Address

Street Number:

Street Name:

Apartment:

City:

State / Province:

Country:

Postal Code / ZIP:

Email Address:

Your Website URL:

Telephone Number

Country Code:

Area Code:

Home Phone:

Business Phone:

Fax Number:

Cellular Phone:

Vital Statistics

Marital Status:

Number of Children:

Ages of Children:

Year of Birth:

Month of Birth:

Day of Birth:

City / Town / Village of Birth:

Country of Birth:

Citizenship:

Permanent Resident of which Country or Countries:

Part 2: Educational Background

Total Years of Schooling (primary up to and including post-graduate):

Highest Level of Education Obtained:

Any type of apprenticeship? (i.e. supervised periods of practical experience) If so, where and for whom?

If you have completed university/college, please answer the question below. Otherwise, move to Part 3.

Name of the most recent university/college, program of study, highest level completed, and dates attended:

	Dates	University/College	Program of Study	Highest Level
1.
2.
3.

Part 3: Employment Background

In the box below, please write in the name of your most recent/current employer, city and country, employment duties and responsibilities, your official title/position, and dates from and to:

Your previous employer, city and country, employment duties and responsibilities, your official title/position, and dates from and to:

What other type of work are you qualified to perform?

What type of work does your spouse do (if applicable)?

Have you ever owned, operated, or controlled a business? Please provide details below:

Part 4: Language Ability

English

I speak English:

Fluently

Well

With Difficulty

Not at All

I read English:

Fluently

Well

With Difficulty

Not at All

I write English:

Fluently

Well

With Difficulty

Not at All

I listen to English:

Fluently

Well

With Difficulty

Not at All

French

I speak French:

Fluently

Well

With Difficulty

Not at All

I read French:

Fluently

Well

With Difficulty

Not at All

I write French:

Fluently

Well

With Difficulty

Not at All

I listen to French:

Fluently

Well

With Difficulty

Not at All

Part 5: Family in Canada

Name:

Address:

Relationship:

Name:

Address:

Relationship:

Part 6: Financial Information

Please provide all monetary amounts in U.S. Dollars

A. What is the total amount of your assets (ex. savings, property, investments)?

B. What is the total amount of your debts/obligations/liabilities?

C. What is your total Net Worth (A - B = C)?

Part 7: Final Questions

Have you or any of your dependants ever:

Had any serious disease or physical or mental disorder?

Yes

Been convicted of or are currently charged with any crime or offence in any country?

Yes

Applied previously for an immigrant or visitor visa to Canada?

Yes

Been refused an immigrant or visitor visa to Canada or any other country?

Yes

Been refused admission to, or ordered to leave Canada or any other country?

Yes

Been involved in the commission of a war crime or a crime against humanity?

Yes

Do you have a job offer from a prospective Canadian employer?

Yes

If you have answered "Yes" to any of the questions above, please provide details below:

Why do you want to come to Canada?

How did you learn about our website?

Other, please specify:

Phone Toll Free 1-888-657-8255

Friday, July 30, 2010