ASSESSMENT FORM

Principal Applicant:

First Name

Last Name

Date of Birth

Country

Full Mailing Address

Residentail Address If different

Phone Number with Country Code

Gender

Male Female Transgender

Marital Status

Married Unmarried Divorced

Nationality

Referred By

Education Histroy

Highest Qualification

University/College Name/Country

From

To

Other Qualification

University/College Name/Country

From

To

Employment Histroy

Current Company Name

Designation

From

To

Other Company Name

Designation

From

To

Language Test

Have you completed any languages test within past 2 years i.e. IELTS, CELPIP etc?

Yes No

Speaking

Writing

Reading

Listening

Spouse Details

First Name

Last Name

Date of Birth

Full Mailing Address if different than Applicant’s

Phone Number with Country Code

Email

Educational History

Highest Qualification

University/College Name/Country

From

To

Employment History

Company Name

Designation

From

To

Language Test

Have you completed any languages test within past 2 years i.e. IELTS, CELPIP etc?

Yes No

Speaking

Writing

Reading

Listening

Children Information

Full Name

Nationality

Date of Birth

Gender

Male Female Transgender

Any Immigration Application Refusal History – If Applicable

Full Name of the Applicant

Country where Applied

Category for Applied

Date of Refusal

Do you or your spouse currently living in Canada?

Full Name of the Applicant In Canada

Status in Canada (i.e. Visitor, Worker, Student)

Permit Start Date

Permit Expiry Date

Do you or your spouse have any relatives in Canada?

Full Name of Relative in Canada

Address of Relative City / State name only

Relationship

Status of Relatives PR/Citizen

Travel Information (If you have travel outside of your origin country please write full details below)

Name of the Country

Status in Foriegn Country

From

To

You may provide additional information that you think would be relevant to your immigration assessment.

If yes then write down below.

‘I understand that my first meeting with Prior Immigration Services includes an initial brief free assessment of my circumstances to see if I qualify for making an application to Canada Immigration. Prior Immigration Services will not accept clients who do not qualify. I will declare at the beginning of the meeting if I am here to discuss any matters that deal with an existing problem with Canada Immigration, an application that has already been submitted, to go into depth on my personal immigration circumstances, or an application which I intend to prepare and submit on my own, as these are NOT included in ‘Prior Immigration & Visa Services’ free assessment, and I agree to pay for the entire consultation at ‘Prior Immigration & Visa Services’ current hourly rate. I agree to provide complete and truthful information in the interview

YES

For Express Entry Permanent Residency / Temporary Residency

Basic Information of Spouse

i.e. PR Application, Student, Visitor, Work Permit, etc. (If yes write full details below)

Principal Applicant:

First Name

Last Name

Date of Birth

Country

Full Mailing Address

Residentail Address If different

Phone Number with Country Code

Gender

Marital Status

Nationality

Referred By

Education Histroy

Highest Qualification

University/College Name/Country

From

To

Other Qualification

University/College Name/Country

From

To

Employment Histroy

Current Company Name

Designation

From

To

Other Company Name

Designation

From

To

Language Test

Have you completed any languages test within past 2 years i.e. IELTS, CELPIP etc?

Speaking

Writing

Reading

Listening

Spouse Details

First Name

Last Name

Date of Birth

Full Mailing Address if different than Applicant’s

Phone Number with Country Code

Email

Educational History

Highest Qualification

University/College Name/Country

From

To

Employment History

Company Name

Designation

From

To

Language Test

Have you completed any languages test within past 2 years i.e. IELTS, CELPIP etc?

Speaking

Writing

Reading

Listening

Children Information

Full Name

Nationality

Date of Birth

Gender

Any Immigration Application Refusal History – If Applicable

Full Name of the Applicant

Country where Applied

Category for Applied

Date of Refusal

Do you or your spouse currently living in Canada?

Full Name of the Applicant In Canada

Status in Canada (i.e. Visitor, Worker, Student)

Permit Start Date

Permit Expiry Date

Do you or your spouse have any relatives in Canada?

Full Name of Relative in Canada