Assessment

ASSESSMENT

Name:
Date of Birth:
Address:
Telephone:
Fax:
E-mail Address:

Marital Status:	never married	married	divorced
Marital Status:	separated	widowed

No. of children:

Any serious disease or physical or mental disorder?

Yes

If yes, please give details:

EDUCATIONAL DETAILS:

Secondary School:
No.of years:	Certificate Diploma

University:
Name:

Faculty/School:

Graduation Year:

No.of years:

Diploma Bachelor Degree

Post University

Master Ph.D.

Vocational/Technical School:

No.of Years:

Certificate; Diploma

LANGUAGES:

English:	Fluently	Well	With difficulty	Not at all
French:	Fluently	Well	With difficulty	Not at all

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WORK HISTORY SINCE GRADUATION:

Present occupation:

Employment period:

Describe in detail your personal duties :

Type of company's activity:

Location(country):

Previous occupation:

Employment period:

Describe your personal duties :

Type of company's activity:

Location(country):

Previous occupation:

Employment period:

Describe your personal duties :

Type of company's activity:

Location(country):

RELATIVES IN CANADA:

Do you have relatives in Canada?	Yes No
Name of relative (if applicable):

Relationship to relative:	brother	sister	parents	grandparents
Relationship to relative:	grandchildren	uncle	aunt	nephew	niece

Mailing address of relative:
Telephone number of relative:

PERSONAL NET WORTH IN US DOLLARS (US$):

Cash (US$):

Property (US$):

Business assets (US$):

Total funds available to transfer to Canada (US$):

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