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Client Eligibility
   
SKILLED WORKER EVALUATION FORM
 

A. Personal Details

Family Name:

Given Name:

Gender:

Male Female

Address:

 

Street and Number:

City:

State:

Country:

Postal Code:

Home phone number:

Business phone number:

Mobile phone number:

Fax number:

E-mail address:

Confirm e-mail address:

Alternate e-mail address:

Date of Birth:

Place of birth:

 

City:

Country:

Citizenship:

Country of residence:

Marital status:

Number of children:

Age of each child:

 

 

B. Spouse's personal details (husband, wife, or common-law partner - if applicable) 

Family Name:

Given Name:

Gender:

Male    Female

Date of Birth:

Place of birth:

 

City:

Country:

Citizenship:

Country of residence:

 

C. Education

Your total years of education:

Highest level of education achieved:

Details of your education history:

-          Full title of each degree/diploma,

-          Period of studies (month/year to month/year),

-          Name of institution and country,

-          Specify if full or part-time studies,

-          Specify whether programme was completed and if degree or diploma was issued.

 

 

D. Spouse’s Education (if applicable)

Your spouse’s total years of education:

Highest level of education achieved:

Details of your spouse’s education history:

-          Full title of each degree/diploma,

-          Period of studies (month/year to month/year),

-          Name of institution and country,

-          Specify if full or part-time studies,

-          Specify whether programme was completed and if degree or diploma was issued.

 

 

E. Your Language Skills

1. English

 

Speak:

Listen (oral comprehension):

Read:

Write:

2. French

 

Speak:

Listen (oral comprehension):

Read:

Write:

 

 

F. Spouse’s Language Skills (if applicable)

1. English

 

Speak:

Listen (oral comprehension):

Read:

Write:

2. French

 

Speak:

Listen (oral comprehension):

Read:

Write:

 

 

G. Your Work Experience

Current job (if currently not working, indicate your current activity):

Job Title:
Name of company or employer:
County where you are working:

Type of employment:

Full-time    Part-time

Period of employment:

From (month/year)  

To (month/year)    

Previous job 1:

 

Job Title:
Name of company or employer:
County where you worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)  

To (month/year)     

Previous job 2:

 

Job Title:
Name of company or employer:
County where you worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)

To (month/year)    

Previous job 3:

 

Job Title:
Name of company or employer:
County where you worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)

To (month/year)     

Previous job 4:

 

Job Title:
Name of company or employer:
County where you worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)

To (month/year)    

Are there any details you wish to add about your work experience?


Arranged employment in Canada:

 Do you or your spouse have a job offer in Canada?

Note: The job offer must be an official offer from a Canadian employer validated by Human Resources and Skills Development Canada (HRSDC)

Yes     No

 

H. Spouse’s Work Experience (if applicable)

Current job:

 

Job Title:
Name of company or employer:
County where you worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)  

To (month/year)     

Previous job 1:

 

Job Title:
Name of company or employer:
County where your spouse worked:

Type of employment

Full-time     Part-time

Period of employment:

From (month/year)

To (month/year)     

Previous job 2:

 

Job Title:
Name of company or employer:
County where your spouse worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)

To (month/year)     

 

 

Previous job 3:

 

Job Title:
Name of company or employer:
County where your spouse worked:

Type of employment:

Full-time     Part-time

Period of employment:

From (month/year)

To (month/year)     

Are there any details you wish to add about your spouse’s work experience?


 

 

I. Adaptability

Have you or your spouse previously studied or worked in Canada?
Yes    
No

You     Your spouse

 

If YES, specify period of study or employment:

FROM (month/year)  TO (month/year) 


Please specify:

-          Full name of employer/school

-          City and province where you or your spouse studied/worked

-          Whether you or your spouse studied/worked full-time or part-time

 

Do you or your spouse have any family members in Canada who are Canadian citizens or permanent residents?
Yes     No
If YES, please specify among the following:

 

 

J. Net Worth

Please indicate your total amount of liquid assets, including your assets and the assets of your spouse in Canadian dollars ($CAD)

 

 

K. Admissibility

Have you, your spouse, or any of your children:

Had any serious disease, physical or psychological disorder?
Yes     No

Been convicted of or are currently charged with a crime or criminal offence in any country?
Yes     No

Previously applied for a temporary visa to Canada?
Yes     No

Previously applied for refugee status or permanent residence in Canada?
Yes     No

Been refused a visa to Canada or any other country?
Yes     No

Been refused admission to or ordered to leave Canada or any other country?
Yes     No

Been involved in a war crime or a crime against humanity?
Yes     No

If you have replied “yes” to any of the above questions, please provide details:

 

 

L. Additional details

If there is anything else that you believe is important in relation to your qualifications please indicate it here.

 

 

M. Declaration

I certify that all the information I provided in this evaluation form is true.

  Yes

 

 

  

 

 
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