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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.

Sep 13, 2019
Update on In-Canada Refugee Processing

  From time to time the Refugee Protection Division of the Immigration and Refugee Board publishes statistics on the progress of claims through i...

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Aug 9, 2019
We Are Growing!

We are pleased to announce that Daniela Dobrota has joined Eisenberg & Young LLP as an associate lawyer. Daniela received a Bachelor of Law and a ...

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Jul 4, 2019
Reduced Eligibility to Make Refugee Claims and the End of the Caregiver Program

  Back in March, 2019 we reported on changes to what used to be called the "Live-In Caregiver Program". On June 18, 2019 these programs essential...

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