(FOR STUDENTS) If you are married, please have your spouse complete this form also. PERSONAL INFORMATION FIRST NAME : LAST NAME : SEX : MALE FEMALE AGE : MARITAL STATUS : SINGLE ENGAGED SEPARATED MARRIED DIVORCED WIDOWED CITIZENSHIP : RELATIVE IN CANADA: (Relatives are 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 WORK HISTORY Choose job title from the occupational list JOB TITLE: DESCRIBE DUTIES AT WORK : YEARS OF EXPERIENCE : PREVIOUS OCCUPATION : YOUR DUTIES : YEARS OF EXPERIENCE : SPOUSES OCCUPATION : LANGUAGE SKILLS ENGLISH SPEAK : FLUENT WELL SOME NONE READ : FLUENT WELL SOME NONE WRITE : FLUENT WELL SOME NONE FRENCH SPEAK : FLUENT WELL SOME NONE READ : FLUENT WELL SOME NONE WRITE : FLUENT WELL SOME 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 : Please include any additional information that may be important :