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Skilled Worker Free Assessment Form
SKILLED WORKER FREE ASSESSMENT FORM
A. PERSONAL DETAILS
Family Name
*
Given Name
Gender
Male
Female
Address
Street
Apartment
City
State
Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Home Phone Number (ex. 416-123-4567)
Business Phone Number (ex. 416-123-4567)
Mobile Phone Number* (ex. 416-123-4567)
Fax Number
E-mail Address
*
E-mail Address*
Confirm E-mail address *
Alternate E-mail address
Date of Birth
Place of birth
Citizenship
Country of Residence
Marital Status
Number of Children
Age of Children
B. SPOUSE’S (HUSBAND, WIFE, OR COMMON-LAW PARTNER) PERSONAL DETAILS (IF APPLICABLE)
Family Name
Given Name
Gender
Male
Female
Date of Birth
Place of Birth
Citizenship
Country of Residence
Marital Status
Number of Children
Age of Children
B. SPOUSE’S (HUSBAND, WIFE, OR COMMON-LAW PARTNER) PERSONAL DETAILS (IF APPLICABLE)
Family Name
Given Name
Gender
Male
Female
Date of Birth
Place of Birth
Citizenship
Country of Residence
C. EDUCATION
Your total number of years of full-time education
Highest level of education achieved
Select
Secondary school
1-year post-secondary credential
2-year post-secondary credential
3 or more year post-secondary credential
Two or more post-secondary credentials, one of which was at least 3 years in duration
University credential at the master’s or professional level
University credential at the doctoral level
Details of education: (provide type of degrees/diplomas, where obtained, full or part-time, area of study, and whether program was completed)
SPOUSE’S EDUCATION (IF APPLICABLE)
Your spouse’s total years of education
Select
Secondary school
1-year post-secondary credential
2-year post-secondary credential
3 or more year post-secondary credential
Two or more post-secondary credentials, one of which was at least 3 years in duration
University credential at the master’s or professional level
University credential at the doctoral level
Details of education: (provide type of degrees/diplomas, where obtained, full or part-time, area of study, and whether program was completed)
D. LANGUAGE SKILLS
ENGLISH
Speak
none
basic
well
fluently
Listen (oral comprehension)
none
basic
well
fluently
Read
none
basic
well
fluently
Write
none
basic
well
fluently
FRENCH
Speak
none
basic
well
fluently
Listen (oral comprehension)
none
basic
well
fluently
Read
none
basic
well
fluently
Write
none
basic
well
fluently
If you have ever been tested for language ability under the IELTS, CELPIC or the TEF test, please record your scores here
SPOUSE’S LANGUAGE SKILLS (IF APPLICABLE)
ENGLISH
Speak
none
basic
well
fluently
Listen (oral comprehension)
none
basic
well
fluently
Read
none
basic
well
fluently
Write
none
basic
well
fluently
FRENCH
Speak
none
basic
well
fluently
Listen (oral comprehension)
none
basic
well
fluently
Read
none
basic
well
fluently
Write
none
basic
well
fluently
If your spouse has ever been tested for language ability under the IELTS, CELPIP or the TEF test, please record their scores here
E. AGE
Date of birth Spouse or partner’s date of birth (if applicable)
F. WORK EXPERIENCE
Total number of years of full-time skilled work experience in the past 10 years
Present job
Previous job 1
Previous job 2
Previous job 3
Previous job 4
Are there any details you wish to add about your work experience?
If you wish to attach your resume please paste it here.
G. SPOUSE’S WORK EXPERIENCE (IF APPLICABLE
Total number of years of full-time skilled work experience in the past 10 years
Present job
Previous job 1
Previous job 2
Previous job 3
Previous job 4
Are there any details you wish to add about your work experience?
H. ARRANGED EMPLOYMENT
Are you currently working in Canada with a work permit for which a Labour Market Opinion has been obtained, and is your employer willing to offer you a permanent position?
Yes
No
Do you have a job offer from a Canadian company that is willing to employ you permanently once you obtain permanent residence?
Yes
No
Is your spouse or partner (if applicable) currently working in Canada with a work permit for which a Labour Market Opinion has been obtained, and is their employer willing to offer them a permanent position?
Yes
No
Does your spouse or partner have a job offer from a Canadian company that is willing to employ them permanently once they obtain permanent residence?
Yes
No
I. ADAPTABILITY
Have you or your spouse or common-law partner studied full-time in Canada for at least a two-year period?
Yes
No
Have you worked full-time in Canada in a skilled occupation for at least a one-year period?
Yes
No
Has your spouse or common-law partner worked full-time in Canada for at least a one-year period?
Yes
No
Do you or your spouse have any family members in Canada who are citizens or permanent resident?
Yes
No
J. NET WORTH
What is your monetary net worth, including your assets and the assets of your spouse, in Canadian dollars?
K. ADMISSIBILITY
Have you, your spouse, or any of your children
Had any serious disease or physical or psychological disorder?
Yes
No
Been convicted of or are currently charged with a criminal offence in any country?
Yes
No
Applied previously for a temporary visa to Canada?
Yes
No
Applied previously for permanent residence in Canada?
Yes
No
Been refused a visa to Canada or any other country?
Yes
No
Been refused admission to or order removed from Canada or any other country?
Yes
No
Been involved in the commission of human rights violations, acts of subversion, espionage, terrorism, or organized criminality?
Yes
No
If you have replied “yes” to any of the above questions, please provide details
L. FINAL DETAILS
If there is anything else that you believe is important in relation to your qualifications please note it here. For example, if you have a resume you can paste it here.
DECLARATION
*
I 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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