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Email:
info@asmaconsulting.com
Québec Office:
001-819-246-9577
Vancouver Office:
001-604-985-1069
Contact details
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ENTREPRENEURS ASSESSMENT REQUEST
Please fill in the following spaces and click on submit button. Our staff will process your request and contact you shortly.
Personal Specifications
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Family Name at Birth:
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Name:
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Other Name that you have used or by which you are known by:
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Sex:
male
female
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Date of Birth (YYYY-MM-DD):
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Birth Place (Province - Region):
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Birth Place (Country):
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Citizenship:
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Present Marital Status:
Single
Married
Separated
Divorced
widowed
Address Specifications
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Residence Address (number, street, app.):
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Postal Code:
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City/Province/Country:
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Phone no. Home-Work (Please include the country code):
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Fax no. Home-Work (Please include the country code):
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Email Address Home-Work:
Language Ability
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French:
Understand Spoken:
None
Beginner
Intermediate
Advanced
Ability to Speak:
None
Beginner
Intermediate
Advanced
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English:
Understand Spoken:
None
Beginner
Intermediate
Advanced
Ability to Speak:
None
Beginner
Intermediate
Advanced
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Education
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Education Highest Level:
High school Diploma
College Degree
Bachelor's Degree
Master's Degree
Ph.D.
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In what country did you obtain this diploma:
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What is the field of training related to this diploma:
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How many years ago did you obtain this diploma:
Relative in Canada
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Do you already have family in Canada?
Yes
No
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Have you ever traveled to Canada in the past 10 years?
Yes
No
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Number of trips to Canada?
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Province:
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Reason of visit:
Work experience
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Do you have owned a business in the past 5 years?
Yes
No
If yes please provide the following details:
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Percentage of company owned:
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Number of employees under your authority:
-
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Do you have professional management experience?
Yes
No
If yes please provide the following details:
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Name of the Organization:
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Worked From (Mm/YYYY/DD):
to (Mm/YYYY/DD):
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Number of employees under your authority:
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Location (City-Province-Country):
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Type of Organization:
Agricultural
Industrial
Commercial
Govenrnmental
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Title/Position:
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Details on your role and duties within the Organization:
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Please indicate the total value of your personal Net worth in Canadian dollars:
0 - 99,999
100,000 - 299,999
300,000 - 799,999
800,000 and +
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Method of accumulation of personal Net worth (business, investment, inheritance):
Spouse Specifications - if applicable
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Present Marital Status:
Single
Married
Separated
Divorced
widowed
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Family Name at Birth and Present Family Name:
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First Name:
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Sex:
male
female
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Date of Birth (YYYY/MM/DD):
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Place of Birth- Province-Region:
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Place of Birth- Country:
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Citizenship:
-
Education- Highest Level:
High school Diploma
College Degree
Bachelor's Degree
Master's Degree
Ph.D.
Children Specifications
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Number of children
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Age from
to
Does the following apply to you, your spouse or any of your children?
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Medical problem:
Yes
No
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if yes, please explain:
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Convicted of or charged with a crime or offence:
Yes
No
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if yes, please explain:
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Refused entry in Canada or any other Country:
Yes
No
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if yes, please explain:
-
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