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Client Self-Assessment Form

If you are married, kindly have your spouse complete a separate assessment form.

Personal information

Family Name:

Given Names:

Date of Birth:

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Sex:

Citizenship:

Country of Residence:

Marital Status:





Name of Spouse: (optional)

Do you have any children?

If you do have children, how many and what are their ages?

Ability in English:

Ability in French:

Have you ever taken a language test?

If you have taken a language test please provide details:

Full Mailing Address (include Country)

Email Address

Primary Phone Number

Secondary Phone Number (optional)

Work information

Current Occupation:

What are you Job Duties and Description:

Start Date of Current Job:

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Previous occupation in the last 10 years (optional):

Start and End Dates of Previous Job:

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Have you ever worked in Canada?

If yes provide details:

Do you have a job offer in Canada?

If yes provide details:

Education information

Years of education:

Highest Level of Education Achieved:






Post Secondary Institution(s)

Please provide the type of degree/diploma, the name/place of the instition and the years you studied there.

Other Education Achieved:

Do you have a Diploma or a Certificate?

If yes provide details:

Have You Ever Studied in Canada?

If yes provide details:

General information

Funds Available to Transfer to Canada in US Dollars:

Do you have any Relatives Living in Canada?

If yes provide details:

Have you or any dependant ever had any serious disease or mental disorder

If yes provide details:

Have you or any dependant ever had a criminal charge or conviction?

If yes provide details:

Have you or any dependent previously applied for an Immigration Visa or Visitor Visa to Canada?

If yes provide details:

Have you or any dependent ever been refused a visa, admission, or ordered to leave Canada or any country?

If yes provide details:

Please provide our office with any additional information you believe we should know about in the box below:

How did you find us?

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If other please provide details:

Recent News

Immigration Law in Canada is constantly changing. Stay up to date with the most recent news pertaining to Citizenship and Immigration Canada laws and regulations.

Jul 11, 2018
News about Canada's Temporary Visa Programs

  This is from the July 9, 2018 edition of the Toronto newspaper The Globe and Mail:   "Last year alone, Canada refused entry to nearly 600,...

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Jul 3, 2018
A Warning about Forms and Procedures

Before filing any kind of application, you should check to see if Immigration has changed the procedure, forms, requested documents, or even the addre...

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Jun 25, 2018
Biometric Collection is Being Expanded

  As of today, people who apply for a visitor, study, or work permit from one of 29 countries plus the Palestinian Authority need to provide a ph...

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