Canadian Immigration Assessment Form

Please fill out the following information and press the submit button. Field with (*) is the required field.

Personal Information

Name*      

                              First                 Last

You are a citizen of * 

   
Your age*  Marital Status
Current Visa Type  

(If in H-1B, the month & year you started working under first H1B: )

 Relative in Canada (You or your spouse)

 
Daytime Phone #*  

                          XXX - XXX - XXXX

Evening Phone #*

                       XXX - XXX - XXXX

Best Time To Call Email* 
Current Address:*     Street 

City*     State/Province*   

Zip/Postal Code*    Country* 

Educational History *

From To Institute's Name/Location Diploma Major

Employment History Within Last 10 Years *

Employer's Name/Location

From

To Occupation Job Description
Current

 
Previous #1

 
Previous #2

 

Additional Information

Language Skills

  Speak Read Write

English

French

Information on Spouse's Education, etc

Your comments

After you have checked all your entries, please press the submit button. Please note that we may not process your application if any field with ( * ) is not filled out.