ASMAConsulting | self emploees

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Email:

info@asmaconsulting.com

Bureau de Québec:

001-819-246-9577

bureau de Vancouver:

001-604-985-1069

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Nos Services

SELF EMPLOYED WORKERS 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

Family Name at Birth:

Name:

Other Name that you have used or by which you are known by:

Sex:

male

female

Date of Birth (YYYY-MM-DD):

Birth Place (Province - Region):

Birth Place (Country):

Citizenship:

Present Marital Status:

Single

Married

Separated

Divorced

widowed

Address Specifications

Residence Address (number, street, app.):

Postal Code:

City/Province/Country:

Phone no. Home-Work (Please include the country code):

Fax no. Home-Work (Please include the country code):

Email Address Home-Work:

Language Ability

French:

Understand Spoken:

None

Beginner

Intermediate

Advanced

Ability to Speak:

None

Beginner

Intermediate

Advanced

English:

Understand Spoken:

None

Beginner

Intermediate

Advanced

Ability to Speak:

None

Beginner

Intermediate

Advanced

Education

Education Highest Level:

High school Diploma

College Degree

Bachelor's Degree

Master's Degree

Ph.D.

In what country did you obtain this diploma:

What is the field of training related to this diploma:

How many years ago did you obtain this diploma:

Relative in Canada

Do you already have family in Canada?

Yes

Have you ever traveled to Canada in the past 10 years?

Yes

Number of trips to Canada?

Province:

Reason of visit:

Work experience

Do you have owned a business in the past 5 years?

Yes

If yes please provide the following details:

Percentage of company owned:

Number of employees under your authority:

Do you have professional management experience?

Yes

If yes please provide the following details:

Name of the Organization:

From (Mm/YYYY/DD): to (Mm/YYYY/DD):

Number of employees under your authority:

Location (City-Province-Country):

Type of Organization:

Agricultural

Industrial

Commercial

Govenrnmental

Title/Position:

Details on your role and duties within the Organization:

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 +

Method of accumulation of personal Net worth ( business, investment, inheritance):

Spouse Specifications - if applicable

Present Marital Status:

Single

Married

Separated

Divorced

widowed

Family Name at Birth and Present Family Name:

First Name:

Sex:

male

female

Date of Birth (YYYY/MM/DD):

Place of Birth- Province-Region:

Place of Birth- Country:

Citizenship:

Education- Highest Level:

High school Diploma

College Degree

Bachelor's Degree

Master's Degree

Ph.D.

Children Specifications

Number of children

Age from to

Does the following apply to you, your spouse or any of your children?

Medical problem:

Yes

if yes, please explain:

Convicted of or charged with a crime or offence:

Yes

if yes, please explain:

Refused entry in Canada or any other Country:

Yes

if yes, please explain:

How did you learn about us?