Канада

CANADA

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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 birth	Current marital status	Date, month, year of the marriage

Specify a previous marriage (if applicable)	Name of previous spouse or partner	Date of birth	Duration 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 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)	Marital status	Residence (Town & Country)

Current address
Street, House number	Postal code	City	Country

Telephone number	E-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 institution	City and country	Type of certificate or diploma issued	Field of study





SPOUSE
From month/year	To month/year	Name of institution	City and country	Type of certificate or diploma issued	Field of study





CHILDREN
Name	Grade	Name		Grade


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, facility	City or town and country	Activity





SPOUSE
From month/year	To month/year	Name of company, employer, school, facility	City or town and country	Activity

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*:	Yes No
Been convicted of a crime or offence in Canada for which a pardon has not been granted under the Criminal Records Act of Canada?	Yes No
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?	Yes No
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)?	Yes No
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?	Yes No
Been refused admission to, or ordered to leave, Canada or any other country?	Yes No
Been involved in an act of genocide, a war crime or in the commission of a crime against humanity?	Yes No
Used, planned or advocated the use of armed struggle or violence to reach political, religious or social objectives?	Yes No
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?	Yes No
Been member of an organization that is or was engaged in an activity that is part of a pattern of criminal activity?	Yes No
Been detained, incarcerated or put in jail?	Yes No
Have relatives, friends or acquaintance in Canada? If “yes”, please provide the name, A address and telephone number:	Yes No

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: