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402-215 Scotland St., Fergus, Ontario, NIM3L8 Canada

+1 (519) 830-5529

Ellis Canadian Immigration

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About Us

Assessment Questionnaire

Please complete the following Assessment Questionnaire form to book a consultation.
We will contact you to arrange an appointment.

Assessment Form

PERSONAL PROFILE

Name of Applicant:

Name of Spouse:

Date of Birth:

Phone:

Email address of Applicant:

Email address of Spouse:

Street Address

City

Region/State/Province

Postal / Zip code

Country

Gender:

Preferred Pronouns:

Country of Citizenship/s:

Country of Residence:

How many children do you have over 22 years old?

How many children do you have under 22 years old?

Do you have a spouse/Common-Law Partner: *

No

Spouse

Common-Law (Live-in for at least 1 year)

EDUCATION

Highest level of education completed:

English language ability *

None

Basic

Intermediate

Advanced

Fluent

Native Language

College/University Program completed:

Have you taken a language test in the past 2 years *

IELTS

CELPIP

TEF

TCF

None

Have you already received an ECA Educational Credential Assessment such as WES? (Economic Immigration Only) *

Yes

No

Not Applicable

EMPLOYMENT

Have you done paid work in the last 10 years? *

Yes

No

Current Occupation:

Employer’s Name:

List your job designations and dates in the past 10 years:

IMMIGRATION STATUS

Status in Canada:

Expiry Date in Canada:

Have you ever submitted any immigration application to Canada before? *

Yes

No

Have you ever had any type of immigration application refused to Canada OR any other country such as the US? *

Yes

No

OTHERS

Preferred destination in Canada?

Are you currently working?

Do you plan to work, study, or visit Canada?

Is your spouse or common-law (live-in partner for at least 1 year) working?

Which type of immigration matter describes what you wish to discuss during your consultation? *

PR through Express Entry or other Economic Stream

Family Sponsorship

PR using any other stream available

Work Permit

LMIA

Visitor Visa

Study Permit

Canadian Citizenship

Other

Do you have source of funds to finance this application? (from personal, parents, relatives, friends, bank loan etc.) *

Yes

No

Are you alone in this application?

Will you bring your spouse and children under 22 years old with you?

Do you have a close friend over 18 years old living in Canada?

Do you have family members or relatives over 18 years old living in Canada?

Do you have a passport? If your answered no, is there any reason why you can’t get it?

Do you have NBI Clearance and any other Police Clearance from countries you’ve been residing or working for more than 6 months?

ADMISSABILITY

Have you, or any of your family members, ever: * Required

a.) Been convicted of a crime or offense in Canada for which a pardon has not been granted under the Criminal Records Act of Canada?

b.) Been convicted of, or are you currently charged with, on trial for, or party to a crime or offense, or subject of any criminal proceedings in any other country or territory?

c.) Made previous claims for refugee protection in Canada or a Canadian visa office abroad, in any other country/ies or territory(ies), or with the United Nations High Commissioner for Refugees (UNHCR)?

d.) Been refused refugee status, an immigrant or permanent resident visa (Including a Certificate de selection du Quebec (CSQ) or application to the Provincial Nominee Program or visitor or temporary resident visa, to Canada or another country or Territory?

e.) Been refused admission to, or ordered to leave, Canada or any other country or territory?

f.) Been involved in an act of genocide, a war crime or in the commission of a crime against humanity?

g.) Used, planned, or advocated the use of armed struggle or violence to reach political, religious or social objectives?

h.) 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?

i.) Been member of an organization that is or was engaged in an activity that is part of a pattern of criminal activity?

j.) Been detained, incarcerated, or put in jail?

check if yes, leave as blank if no

If your answer to any of the questions from sub-section a) to i) is YES, provide details.

Please briefly describe your immigration inquiries so we can assist you.

Is there anything else that we need to know?

By typing my name, I hereby certify that this document is legally executed by the person named herein as the Client, and that I understand and acknowledge all the above information to be true, correct, and complete.

Today's date:

Thanks for submitting!
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Regulated under the license of:

Alma Ellis, RCIC
R710549
alma.ellis@ellisimmigration.ca

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