Family Name
Given Name
Male
Female
Street
Apartment
City
State
Country
Postal Code
Home Phone Number
Business Phone Number
Mobile Phone Number
Fax Number
Email
Confirm Email
Alternate Email
Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Citizenship
Country of residence
Are you married, or do you have a common-law partner?
Do you have any children?
If yes, how many children do you have and what are their ages?
What is your monetary net worth in Canadian dollars including your assets and the assets of your spouse?
Are you a Manager or Business owner? Please Select One Manager Business Owner
Have you managed at least 5 employees in a business within the last 5 years?
If yes, for how many years? (1-5) Please Select One 1 2 3 4 5
Have you owned and managed a business within the last five years?
Year 1:
Year 2:
Year 3:
Year 4:
Year 5:
Year 1: %
Year 2: %
Year 3: %
Year 4: %
Year 5: %
Please provide a description of your business activities including the following information: type of business, your position in the business, your duties in the business, and any other details you believe are relevant.
Your total number of years of full-time education
Level of education achieved Please Select an Option Secondary school 1-year non-university post-secondary credential 1-year university credential at bachelor's level 2-year non-university post-secondary credential 2-year university credential at the bachelor’s level 3-year non-university post-secondary credential 3-year university credential at bachelor's level 4-year university credential at bachelor's level Two or more university credentials at the bachelor's level University credential at the master's or doctoral level
Choose a Language English French
Speaking None Basic Well Fluently
Listening None Basic Well Fluently
Reading None Basic Well Fluently
Writing None Basic Well Fluently
Have you made an exploratory business visit to Canada within the last 5 years?
Had any serious disease or physical or psychological disorder?
Been convicted of or are currently charged with a criminal offence in any country?
Applied previously for a temporary visa to Canada?
Applied previously for permanent residence in Canada?
Been refused a visa to Canada or any other country?
Been refused admission to or ordered removed from Canada or any other country?
Been involved in the commission of human rights violations, acts of subversion, espionage, terrorism, or organized criminality?
If you have replied “yes” to any of the above questions, please provide details
If there is anything else that you believe is important in relation to your case please note it here.
I (first name, last name) certify that the above information provided by me in the Free Assessment is true.
Furthermore, I consent to the law office of Matthew Jeffery, Barrister & Solicitor, contacting me in relation to the above Free Assessment.
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