Citizenship Application Assessment Form All information submitted is kept strictly confidential. View Privacy Policy A. PERSONAL DETAILSFull Name*Email Address*Phone Number*GenderMaleFemaleFull Postal AddressPlace of BirthDate of BirthCitizenship*Country of ResidenceNumber of ChildrenMarital StatusPlease selectSingle / Never MarriedMarriedDivorced / WidowedCommon LawConjugal Relationship Are you a permanent resident of Canada?YesNoWhen did you obtain permanent residence?Prior to obtaining permanent residence, were you a temporary resident in Canada?YesNoDuring what period were you a temporary resident?Have you physically resided in Canada for at least 3 years in the past 5 years?YesNoHow many days have you been in Canada in the last 5 years?How often have you travelled out of Canada in the past five yearsPlease selectDid not travelOccasionallyFrequentlyWhat countries have you travelled to in the past 5 years?Are you able to speak English or FrenchYesNoWhat language do you speak?What level is your English or French at? Please selectFluentModerateBasicNoneHave you been filing income tax returns in Canada for at least 3 of the past 5 years?YesNoB. APPLICANT ADMISSIBILITYHave you been convicted of or are currently charged with a criminal offence in any country?YesNoAre you currently under a removal order?YesNoAre you imprisoned, on parole, or on probation?YesNoHas your Canadian citizenship previously been revoked?YesNoHave you been convicted of human rights violations, war crimes or crimes against humanity, acts of subversion, espionage, or terrorism? YesNoIf you have replied “yes” to any of the above questions, please provide details:C. FINAL DETAILSIf there is anything else that you believe is important in relation to your case please note it here:DECLARATIONI certify that the above information provided by me in the Free Assessment is true.*Yes, TrueFurthermore, I consent to the law office of Matthew Jeffery, Barrister & Solicitor, contacting me in relation to the above Free Assessment.*YesSendThis field should be left blank