Free Trade Worker Assessment Questionnaire - GreenCard - Immigration to America

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Canadian Citizenship & Immigration Resource Center (CCIRC) Inc.
Law Offices of Colin R. Singer

Free Trade Worker Assessment Questionnaire

Complete the following questionnaire to receive a free assessment of your qualifications for Temporary Work Visa as a Trade Worker applicant.

Personal Information
Name:
Email Address: In order to receive a reply, kindly ensure that you have sufficient space in your e-mail account. In addition, for Hotmail and Yahoo users our reply may be filtered as "Junk Mail".
Nationality:
Current Place of Residence: (City,Country)
Daytime Telephone number preceded by the area code: (areacode , phone number) Home, Office, or Mobile
Date of Birth:	Day Month Year
Sex:	Male Female
Marital Status :	Single Married Divorced/Separated
If Married, please provide Spouse's Characteristics in the fields below
Spouse's Date of Birth:	Day Month Year
Spouse's Level of Education and duration:	(If other please specify)
Spouse's total years of education: (Starting from primary school)
Spouse's field of study:
Spouse's Number of Years and Months of Working Experience:
Language Ability in French:
Number of Dependant Children:

Ability in English and French
English
Read
Write
Speak
Listen

French
Read
Write
Speak
Listen

Educational Profile
Total Years of education: (Including Primary, Secondary, and Post Secondary)
1. Certificate:	(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

2. Certificate:	(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

3. Certificate:	(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

Employment History
1. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status:	Part Time Full Time
Number of Hours Worked per Week:	Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties: (please provide details)
City:
Country:

2. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status:	Part Time Full Time
Number of Hours Worked per Week:	Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties: (please provide details)
City:
Country:

3. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status:	Part Time Full Time
Number of Hours Worked per Week:	Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties: (please provide details)
City:
Country:

If you have additional experience, please include in the Additional Comments below.

Other
• Relationship to Closest Blood Relative in Canada (Canadian Citizen or Landed Immigrant):
Blood Parent Blood Aunt/Uncle Blood Brother or Sister Blood Son/Daughter Blood Niece/Nephew (22 years or older) Blood Grand ParentBlood Cousin
Relative Province of Residence :

• Personal Net worth (CAD$):

• Do you currently have an offer of employment from a Canadian employer?	Yes	No
If your answer to the above question is "Yes" provide details here:

• Have you or spouse/common law partner or dependent children ever:
Had any serious disease	Yes	No
Been convicted of or currently charged with any crime or offence in any country	Yes	No
Applied previously for an immigrant visa to Canada	Yes	No
Visited Canada (visit,study,work)	Yes	No
Are you able to obtain a visitors visa to Canada	Yes	No
If answer to any of above is "Yes" provide details here:

• PLEASE INFORM US HOW YOU WERE INTRODUCED TO THIS SITE:
	Search Engine (please specify name & keywords used for the search)
	Newspaper or Magazine (please specify)
	Newsgroup (please specify)
	General Recommendation