Canadian Business Immigrant Self-Employed FREE Assessment

Principal Applicant - Personal Information
Please ensure to complete the assessment below pertaining to your personal information. It is very important to provide us with a valid contact number and advise us of any changes in your personal information and contact numbers. * Indicates field required

Surname/Family Name:*
First Name:*
Sex:*
Date of Birth:*
City/Town of Birth:*
Country of Birth:*
Citizenship:*
Marital Status:*
Number of Children:
Ages of Children:
Home Telephone: (include area code)*
Work Telephone: (include area code)
Fax Number: (include area code)
Cellular/Mobile Number: (include area code)
Email: (please ensure your email is active)* if you don't have have an E-mail address, click here
Other Contact Number: (include area code)
Current Address* Street Name and Number:*
City/Town:*
Province/State:
Postal/Zip Code:
Country:*
How long have you legally resided in this country?*
List other countries that you have legally resided for at least 1 year in the past.

Principal Applicant - Education
Please enter the boxes correctly indicating the number of years completed at each level of education (e.g primary school - 6 years, apprenticeship - 2 years). It is very important to correctly account the number of years completed at each level to better assess your application. * Indicates field required

Highest Level of Education:*
Highest Qualification Designation:* e.g. BS in Engineering

Education	Diploma Attained	Indicate the number of years completed in this level of education
PhD:
Master Degree:
2nd Bachelor Degree:
1st Bachelor Degree:
Apprenticeship:
Secondary/High School:
Primary/Elementary School:

Principal Applicant - Language Ability
Language ability is one component that is essential in the application. Please ensure that you correctly complete the fields below. * Indicates field required
Indicate your first official language*:
If your language ability is in both English and French, decide which of the two will be your first official language
Language	Speaking	Reading	Writing	Listening
English*
French*
Have you taken the following language examination?: If yes, indicate your test results.		IELTS	CELPIP	TEF
	Speaking	Reading	Writing	Listening

Principal Applicant - Work Experience
Please indicate below your work experience. Work experience MUST be PAID FULL TIME employment within the last 10 years. Full time employment is considered as 37.5 hours per week.NOTE: Work experience obtained prior to 10 years ago from today's date will not be credited.
	Occupation	Years of Experience	Job Description
1	*	*
2
3
4
5

Financial Information
Please indicate below your and your spouse's, if applicable, personal net worth in CAD Dollars. 1. List all your liquid assets and their current value (e.g. cash, bonds, savings, stocks). 2. List all your fixed assets at their current value (e.g. house, car, land). 3. Pension and mutual Funds and their current value. 4. Business (specify your % of ownership and its current value). 5. List your liabilities and personal debt and the current value. 6. Add all your liabilities and personal debt and subtract the sum of your total liabilities and personal debt to the sum of all your assets (add the value of 1+2+3+4). * Indicates field required

Total Net Worth:*	CAD $
Indicate the total value of funds already in Canada, if applicable:	CAD $

Spouse/Common-Law Partner (if applicable) - Personal Information
If you have a spouse or a common-law partner or same sex partner, please complete the questionnaire below. If you are SINGLE/NEVER MARRIED, please proceed to Adaptability/Arranged Employment.
Surname/Family Name:*
First Name:*
Sex:*
Date of Birth:*
City/Town of Birth:*
Country of Birth:*
Citizenship:*
Home Telephone: (include area code)*
Work Telephone: (include area code)
Fax Number: (include area code)
Cellular/Mobile Number: (include area code)
Email: (please ensure your email is active)*
Other Contact Number: (include area code)

Spouse/Common - Law Partner Education
Highest Level of Education:*
Highest Qualification Designation:* e.g. BS in Engineering
Education	Diploma Attained	Indicate the number of years completed in this level of education
PhD:
Master Degree:
2nd Bachelor Degree:
1st Bachelor Degree:
Apprenticeship:
Secondary/High School:
Primary/Elementary School:

Spouse/Common-Law Partner - Language Ability
Language ability is one component that is essential in the application. Please ensure that you correctly complete the fields below. * Indicates field required
Indicate your first official language*:
If your language ability is in both English and French, decide which of the two will be your first official language
Language	Speaking	Reading	Writing	Listening
English*
French*
Have you taken the following language examination?: If yes, indicate your test results.		IELTS	CELPIP	TEF
	Speaking	Reading	Writing	Listening

Spouse/Common-Law Partner - Work Experience
Please indicate below your work experience. Work experience MUST be PAID FULL TIME employment within the last 10 years. Full time employment is considered as 37.5 hours per week. NOTE: Work experience obtained prior to 10 years ago will not be credited.
	Occupation	Years of Experience	Job Description
1
2
3
4
5

Adaptability/Arranged Employment
Do you or your spouse/common-law partner, if applicable, have an Arranged Employment Opinion from Service Canada?*
Do you or your spouse/common-law partner, if applicable, have a confirmed Labor Market Opinion from Service Canada from a prospective Canadian employer?*
Did you or your spouse/common-law partner, if applicable, worked in Canada full time on a valid work permit for a minimum of at least 1 year?*
Did you or your spouse/common-law partner, if applicable, studied in Canada full time on post secondary study on a valid study permit for a minimum of at least 2 years?*
Do you or your spouse, if applicable, have a relative residing in Canada that is a Permanent resident or Canadian?*
Currently working in Canada on a valid temporary work permit?*
Currently working in Canada on a valid temporary work permit that is Service Canada confirmation exempt?*

Admissibility
Do you or your spouse and/or any of your dependants, if applicable ever:
Been detained or in jail?*
Been convicted of or are currently charged with any crime or offence in any country?*
Applied previously for any temporary resident visa to Canada (visitor, work, study)?*
Been refused a Canadian visa?*
Had any serious disease or physical mental disorder?*
Been involved in act of genocide, war crimes, commission of crime against humanity?*
Been refused admission to, or ordered to leave Canada or any other country?*
Previously sought Refugee status or applied for permanent resident visa to Canada?*
Been a member of an organization that is engaged in criminal activities?*
Been associated with a group that advocates or implements violence to reach political, religious or social objectives?*
If you have answered "yes" to any of the questions the above, please provide details below:

Additional Information
How did you learn about our website?*
How did you learn about our services?*
Other - specify:
Please indicate the reason you have contacted *Canada Immigration Consulting Agency Co. (CICA).**
Please indicate how Canada Immigration Consulting Agency Co. (CICA) can assist you*.