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001-604-985-1069
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SKILLED 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
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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
Education
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Education Highest Level:
General high school diploma
Professional high school diploma
General post-secondary diploma after 13 years of full-time education
Technical post-secondary diploma 2 years after 13 years of full time education
Technical post secondary diploma 3 years after 14 years of full time education
Undergraduate diploma of university studies 3 or 4 years-after 16 years of full-time education
Graduate diploma of university studies 1or 2 years-after 17 to 19 years of full-time education
Post graduate diploma of university studies 3 years or more-after completing 21 years of full time education or more
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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:
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Have you already practiced a profession that pertains directly to your field of training?
Yes
No
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If yes, how long did you hold that position?
Less than 6 Months
6 Months to 11 Months
12 Months or more
Work experience
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How many months or years of full-time professional experience including military service, have you completed during the past 5 years?
Have you received an offer of employment in Québec?
Yes
No
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Please provide details:
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Please insert your resume in the following space:
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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):
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:
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:
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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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How did you learn about us?
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