General Canadian Immigration Assessment Form - Immigration, Refugees and Citizenship

Name

First

Last

Date of Birth

DD/MM/YYY

Place of Birth

Nationality at Birth

Marital Status

Single: Not married or in a civil partnership.
Married: Legally married to a spouse.
Divorced: Legally divorced from a spouse.
Widowed: Surviving spouse of a deceased partner.
Separated: Living apart from a spouse but not legally divorced.
In a Civil Partnership: In a legally recognized partnership similar to marriage.
In a Common-Law Relationship: Living together in a relationship resembling marriage but without legal recognition.

Current Address

Phone Number

Email Address

Educational Qualifications Obtained

Have you studied in Canada?

Any other certificates or educational courses

Occupation

Current (or most recent) Job

Previous places of employment

Positions held in the past 5 years

of Any the

level of proficiency in English or French

Names of family members accompanying the applicant (in the case of family immigration or bringing a spouse and children)

What amount of money can you bring to Canada?

In US Dollars

Has the applicant ever been convicted of a criminal offense?

If the answer is yes, explain the reason

Do you have any serious health issues that may affect your immigration eligibility?

If the answer is yes, explain the reason