Full Name

Email Address

Telephone

Age

Country of Residence

Marital Status Marital StatusSingleMarriedCommon Law Partner

Preferred Destination in Canada

Please describe your proficiency in English Please describe your proficiency in English Expert Good Competent Limited None at all

Please describe your proficiency in French Please describe your proficiency in French Expert Good Competent Limited None at all

Do you have any children under the age of 22? Do you have any children under the age of 22? YesNo

Have you completed high school (secondary school)? Have you completed high school (secondary school)?YesNo

Have you done any paid work during the last 10 years? Have you done any paid work during the last 10 years?YesNo

Have you already submitted an Express Entry profile to the Government of Canada within the past 12 months Have you already submitted an Express Entry profile to the Government of Canada within the past 12 months YesNo

Do you have a written job offer from a Canadian employer? Do you have a written job offer from a Canadian employer?YesNo

Do you have any family members or relatives living in Canada and who are 18 years or older? Do you have any family members or relatives living in Canada and who are 18 years or older?YesNo

Your personal Net worth in Canadian $. (optional) It is considered for some immigration programs.

Questions and Comments if you feel any other information relevant to your immigration assessment.

Immigration Newsletter Immigration Newsletter Yes, please send me the free Canadian Immigration Newsletter by email.