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PRE-QUALIFICATION QUESTIONNAIRE
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PRE-QUALIFICATION QUESTIONNAIRE
PRE-QUALIFICATION QUESTIONNAIRE:
First Name
*
Last Name
*
City and Country of residence
*
Citizenship (if different from country of residence):
Address
Email
*
Birth date
Marital Status
Single
Married or Common-Law
Divorced
Widow
Other
Home phone
Work phone
Cell phone
Have you or any member of your family applied to come to Canada before?
Yes
No
When?
If your application was refused, please specify the reason
In what language do you prefer to be contacted?
*
English
French
Spanish
Russian
Korean
German
Other
Other Language
What is the best time to contact you; at what telephone number do you prefer to be contacted?
*
During working hours (9:00 a.m. to 5:00 p.m.)
After working hours/evening (7:00 p.m. to 9:00 p.m.)
Weekends/Saturday or Sunday
Home phone, Work phone or Cell phone
Education
Highest level of education completed
Elementary School
Secondary School
Institute
University
Post-graduate
Master/PhD
Name of Degree obtained
KNOWLEDGE OF LANGUAGE
ENGLISH
Reading-English
Non-Reader
Basic
Moderate
Advanced
Writing-English
Non-Writer
Basic
Moderate
Advanced
Speaking-English
Non-Speaker
Basic
Moderate
Advanced
Listening-English
Don’t Understand
Basic
Moderate
Advanced
FRENCH
Reading-French
Non-Reader
Basic
Moderate
Advanced
Writing-French
Non-Writer
Basic
Moderate
Advanced
Speaking-French
Non-Speaker
Basic
Moderate
Advanced
Listening-French
Don’t Understand
Basic
Moderate
Advanced
NET WORTH:
The information provided to us in the following questions will be handled with strict confidentiality following Regulation 8.1 of the Code of Professional Ethics of ICCRC (Immigration Consultants of Canada Regulatory Council): “An ICCRC member has a duty to hold in strict confidence at all times all information concerning the personal and business affairs of a Client acquired during the course of practice and should not disclose such information unless disclosure is expressly or implicitly authorized by the Client, required by law or by a tribunal of competent jurisdiction, or is otherwise permitted by this Code”.
Provide an estimate of your total assets (business, real estate, insurance, investments, etc.) in C$.
*
Personal assets only
Yes
No
Includes my spouse’s assets.
Yes
No
If you own a business please provide a brief description of industry sector, type of business, # of employees, products or services offered, # of years in business, etc
Provide an estimate of your total liabilities (short-term debt, long-term debt, government loans, etc.) in C$:
Personal liabilities only
Yes
No
Includes my spouse’s liabilities
Yes
No
Indicate which of the following sectors are of interest to you for business investment (check all that apply)
Information Technology
Telecommunications
Health/Pharmaceutical
Energy/Oil
Retail
Manufacturing
Real Estate/Construction
Food
Import/exports
Public Companies
Work Experience
(Last 10 years starting from your most recent employment)
Work Experience 1:
Start date
End date
Occupation/Position
Type:
Part-time
Full-time
Employer’s name
Work Experience 2:
Start date
End date
Occupation/Position
Type:
Part-time
Full-time
Employer’s name
Work Experience 3
Start date
End date
Occupation/Position
Type:
Part-time
Full-time
Employer’s name
FAMILY INFORMATION:
Details of persons to be included in your application
Name, relationship to you, age
Name, relationship to you, age
Name, relationship to you, age
Name, relationship to you, age
Do you or any of your dependants have any medical condition?
Yes
No
If Yes, please explain
Have you or any of your dependants been convicted of a criminal offence?
Yes
No
If Yes, please explain
OTHER INFORMATION:
Which program are you interested in?
*
Federal Investor
Federal Entrepreneur
Federal Self-Employed
Do not know
Provincial Nominee Program for:
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
Nova Scotia
New Brunswick
Prince Edward Island
Nortwest Territories
Yukon
How did you find about us? Check all that apply
Newspaper ad
Google search
Facebook
Twitter
Other: