CANADA

Our goal is to make your dream come true

Please be assured that any information which you supply will be treated in the strictest confidence. Please carefully review the questionnaire and fill it out completely. We will assess your immigration possibilities based on the provided information which has to be true and accurate. You can send back the questionnaire by e-mail: info@cciss.ca After we have received the filled out questionnaire, we will provide you with your personal application evaluation within 10 to 15 business days. The service to evaluate your chances is free of charge.

QUESTIONNAIRE

or fill the form:



PERSONAL DATA AND CONTACT  INFORMATION 


Family name
Given name
Name at birthCurrent marital statusDate, month, year of the marriage

Specify a previous marriage (if applicable)Name of previous spouse or partnerDate of birthDuration of relationship (from-till)
Principal Applicant
Spouse








Family members, who will accompany you to Canada (including the principal applicant).



Family name

Given name

Date of birth

Day/Month/Year
Place of birth (town, city)
Country of birth
Relationship (daughter, son, step- son and so on)Citizenship

Family members, who will not be accompanying you to Canada

(including children from a previous marriages, adopted children, children who are married).
Family nameGiven name

Date of birth

Day/Month/Year
Place of birth (town, city)Country of birth)Relationship (daughter, son, step- son and so on)Marital status

Residence

(Town & Country)


Current address


Street, House numberPostal codeCityCountry
Telephone numberE-mail   Skype



 LANGUAGE  PROFICIENCY

How would you rate your English and French knowledge on a scale of 0-10?
(0 - no knowledge, 10 - fluent)

Languages

Principal

applicant
Spouse

1st  Child 

Name:

2nd  Child

Name:

3rd  Child

Name:

4th Child

Name:

5th Child

Name:

English
French
Native language:



EDUCATION


Post-Secondary Education/ Vocational Training/ Continuous Education (please fill out completely)
PRINCIPAL APPLICANT
From month/year
To month/year
Name of institutionCity and countryType of certificate or diploma issuedField of study
SPOUSE
From month/year
To month/year
Name of institutionCity and countryType of certificate or diploma issuedField of study
CHILDREN
NameGradeNameGrade

EMPLOYMENT

Please state your work history since the age of 18 or the past 10 years, whichever is most recent: (e.g. apprenticeship, work, military service, unemployment, etc.). Your time line should be consistent and without any gaps. If you had time off between jobs for whatever reason, indicate the dates and state the reason. 
PRINCIPAL APPLICANT
From month/year
To month/year
Name of company, employer, school, facilityCity or town and countryActivity
SPOUSE
From month/year
To month/year
Name of company, employer, school, facilityCity or town and countryActivity


Have you, or any of your family members listed in your application for permanent residence in Canada, ever
(If your answer to any of these questions is YES, provide the detailed explanation on a separate sheet of paper)

Been in Canada. If yes, please provide details: period from to ; place:


Been convicted of a crime or offence in Canada for which a pardon has not been granted under the Criminal Records Act of Canada?
Been convicted of, or are you currently charged with, on trial for, or party to a crime or offence, or subject of any criminal proceedings in any other?
Made previous claims for refugee protection in Canada or at a Canadian visa office abroad, in any other country or countries, or with the United Nations High Commissioner for Refugees (UNHCR)?
Been refused refugee status, an immigrant or permanent resident visa (including a Certificat de selection du Quebec (CSQ) or application to the Provincial Nominee Program) or visitor or temporary resident visa, to Canada or any other country?
Been refused admission to, or ordered to leave, Canada or any other country?
Been involved in an act of genocide, a war crime or in the commission of a crime against humanity?
Used, planned or advocated the use of armed struggle or violence to reach political, religious or social objectives?
Been associated with a group that used, uses, advocated or advocates the use of armed struggle or violence to reach political, religious or social objectives?
Been member of an organization that is or was engaged in an activity that is part of a pattern of criminal activity?
Been detained, incarcerated or put in jail?
Have relatives, friends or acquaintance in Canada? If “yes”, please provide the name, A address and telephone number:



Please use this space to provide additional information that you would like we to know about you and your family or to ask questions about immigration to Canada: