Citizenship Application Assessment FormA. PERSONAL DETAILSFamily Name*Given Name*GenderMaleFemaleFull Postal AddressPhone Number*Email Address*Confirm Email Address*Alternate Email Address*Place of BirthDate of BirthCitizenship*Marital StatusNumber of ChildrenCountry of Residence 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 2 years in the past 5 years?YesNoHow many days have you been in Canada in the last 5 years?Are you able to speak moderate English or French?YesNoWhat language do you speak?What level is your English or French at? Have 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?YesNo Are 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under a removal order?YesNoAre you imprisoned, on parole, or on probation?YesNoHas your Canadian citizenship previously been revoked?YesNoHave you been convicted of human rights violations, war crimes or crimes against humanity, acts of subversion, espionage, or terrorism?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:E. 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