CQ Consulting - Independent Class Immigration Free Assessment Form

Independent (Skilled Worker) Class Immigration Free Assessment Form

Please complete the questionnaire below so that we can return your FREE online assessment.
Once completed, please press the submit button found at the bottom of this page.

Step 1 : General Information
Family or Surname	First Name	Initial	Title	Gender

Street Number and Street Name	Apartment Number	City

State/Province	Zip/Postal Code	Country

Telephone Country Code - Area Code	Home Telephone Number	Business Telephone Number
..
E-mail Address	Mobile/Cellular Number	Fax Number

Birth Date, Month and Year	City or Town of Birth	Country of Birth

Marital Status	No of Children -Ages	Citizenship

Do you have a Spouse/Common-Law Partner/Same-Sex Partner ?.......Yes No
Spouse/Partner Full Name	Title ...............Gender	Birth Date, Month and Year

Step 2 : Educational Background
Confirm Highest Level of Education completed:
Exact details of Highest Qualification Received	eg. BSc. Engineering
Name of Institution	From Date	M Y
City and Country	To Date	M Y
.

Step 3 : Educational Background - Spouse/Partner
.This section MUST be completed if you have indicated in Step 1 that you have a Spouse/ Partner, otherwise proceed to Step 4.
Confirm Highest Level of Education completed:
Exact details of Highest Qualification Received	eg. BSc. Engineering
Name of Institution	From Date	M Y
City and Country	To Date	M Y
.

Step 4 : Employment Background - Applicant
How many years of full-time skilled work experience do you have to your credit within the past ten (10) years ? (Do NOT include incomplete/partial years)
Please provide below all details of your employment within the past ten (10) years up to and including the present day. Alternatively, cut and paste your CV into the box. Be sure to include: Dates Worked (from month/year to month/year) Job Title/Position Held Company Name and Location Duties and Responsibilities If you do not have any work and/or business experience of any kind type NONE in the box below and move on to Step 5.

If you have owned, operated, or controlled a business within the past five (5) years OR if you have held a management position in a company within the past five (5) years, please provide the following details for EACH year (i.e. 1997, 1998, 1999, 2000, 2001) : Name of Business and Nature of Business Number of employees you managed/who worked for you Annual Sales (in $US) Your Net Income (in $US) Your Equity in the Business (%) Value of your Equity (in $US)


Step 5 : Employment Background - Spouse/Partner
If you do not have a Spouse/Partner move on to Step 6.
How many years of full-time skilled work experience does your Spouse/Partner have to her/his credit within the past ten (10) years ?
Please provide below all details of your Spouse/Partner's employment within the past ten (10) years up to and including the present day. Be sure to include: Dates Worked (from month/year to month/year) Job Title/Position Held Company Name and Location Duties and Responsibilities

If your Spouse/Partner has owned, operated, or controlled a business within the past five (5) years OR if your Spouse/Partner has held a management position in a company within the past five (5) years, please provide the following details for EACH year (i.e. 1997, 1998, 1999, 2000, 2001) : Name of Business and Nature of Business Number of employees Annual Sales (in $US) Net Income (in $US) Your Spouse/Partner's Equity in the Business (%) Value of Equity (in $US)


Step 6(a) : Language Ability - Applicant
Select	Speak	Read	Write	Understand
English
French

Step 6(b) : Language Ability - Spouse/Partner
This section MUST be completed if you have a spouse or partner.
Select	Speak	Read	Write	Understand
English
French

Step 7 : Family in Canada
If you or your Spouse/Partner have/has a relative, who is a Canadian Citizen/Permanent Resident please supply information below, otherwise, move to Step 8. A qualifying relative is defined as a family member or blood relative to you the Applicant or your Spouse/Partner found in the menu below.
Name of Relative
Relationship
Address
m

Step 8 : Financial Information - this section MUST be completed
N.B. Please provide all monetary amounts in $US (U.S. Dollars). Enter number in $US only. Do not insert commas, periods, currency sign or any other characters - i.e.numbers only.
A. What is the total amount of both personal AND business assets of you and your spouse/common-law partner/same-sex partner ? (i.e. savings, real estate, property, investments, jewellery, etc.)	$US
B. What is the total amount of the debts/obligations/liabilities of you and your spouse/common-law partner/same-sex partner ? (i.e. loans, mortgages, tax arrears, bills, etc.)	$US

Step 9 : Final Questions
Have you or any of your dependants ever:
had any serious disease or physical or mental disorder ?
been convicted of or are currently charged with any crime or offence in any country ?
applied previously for temporary status in Canada (i.e. visitor/student/worker) ?
been refused a Canadian immigrant visa /visitor visa /Study Permit /Work Permit or that of any other country ?
been refused admission to, or ordered to leave Canada or any other country ?
been involved in the commission of a war crime or a crime against humanity ?
applied previously for permanent status in Canada ?

Do you have a job offer from a prospective Canadian employer ?

If you have answered "yes" to any of the questions above, please provide details below:

How did you learn about our website ?

Specify other source here (if applicable):

Do you currently have an Application for Permanent Residence in process that was either filed by yourself or by any third party individual/lawyer/law firm/consultant/consultancy service/company on your behalf ?

Declaration - MUST be completed:
I agree that the information furnished by me in the above form is true and correct, to the best of my knowledge, and provided for the sole purpose of my FREE assessment regarding Immigration to Canada.	Yes No

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