(For skilled workers) If you are married, please have your spouse complete this form also. PERSONAL INFORMATION First Name : Last Name : Sex : MALE FEMALE Date of Birth (dd/mm/yyyy) : Marital Status : SINGLE ENGAGED SEPARATED MARRIED DIVORCED WIDOWED Citizenship : Name of spouse: Ocupation of Spouse : No. children under 18 : No. of 18+ going to College : Relative in Canada: (Relatives are Landed Immigrants or citizens of Canada) YES NO YES NO Parents Uncle Brother Nephews Sister Nieces Aunt Grandparents Address : (Please fill in proper address for correspondence if required.) Phone number: Fax number : E-Mail : EDUCATION Highest level of Education: Ph. D. Master's Degree Bachelor's Degree University Certificate/Diploma Some university, but no degree 2-year College Diploma/Certificate Formal trade: Certificate/Apprenticeship High School graduate No education Certificates : list type of degree/diploma/certificate. Years to complete: YEARS Other education: list type of degree/diploma/certificate. Years to complete : YEARS Education history for, High School, Apprenticeship, Others : (INTENDED OLNY FOR THOSE WITHOUT A DEGREE. Please indicate in chronincal order. For each level please state From (Month, year to Month year, Certificate or Diploma obtained.) WORK HISTORY Choose job title from the occupational list Current Job Title: Describe duties at work : Years of experience : Previous occupation : Your duties : Years of experience : LANGUAGE SKILLS ENGLISH SPEAK : FLUENT WELL WITH DIFFICULTY NONE READ : FLUENT WELL WITH DIFFICULTY NONE WRITE : FLUENT WELL WITH DIFFICULTY NONE FRENCH SPEAK : FLUENT WELL WITH DIFFICULTY NONE READ : FLUENT WELL WITH DIFFICULTY NONE WRITE : FLUENT WELL WITH DIFFICULTY NONE OTHER INFORMATION Have you been convicted or currently charged with a crime in any country? YES NO Previously sought refugee status or applied for an immigrant or visitor visa in Canada? YES NO Been refused refugee status/immigrant/visitor 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 detained or incarcerated? YES NO Do you or your spouse or children have any serious disease or physical or mental disorder? YES NO If you answered "YES" to any of the above, provide further details : FINANCIAL INFORMATION (US$) Real Estate : Bank Accounts: Fixed Deposits : Others : Debts : Net worth : Please include any additional information that may be important :
