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Canadian Immigration Law Firm of Lorne Lichtenstein

Preliminary Questionnaire

We shall use this questionnaire to elicit basic personal information to perform a preliminary assessment of your chances of qualifying for immigration to Canada. The information you provide will be kept in strictest of confidence and not released to third parties for any reason. However, you should know that any information provided over the Internet is not necessarily secure. We cannot assume responsibility for unauthorized interception of Internet information.

If you wish to provide the basic information requested below, we will respond with a preliminary assessment by e-mail, fax or post.

Personal

First Name:
Last Name:
Date of birth:
Nationality:
Country of current residence:
Gender:Male  Female
Your age:
Marital Status:


Language Ability

English:Read
Write
Speak
Comprehend
French:Read
Write
Speak
Comprehend


Education

Highest Level of Education Achieved


Name of educational institution


Name of Degree (include area(s) of specialization)

(i.e. B.Sc. Major Computer Programming)

Year of graduation from the educational institution



Work experience

Select  any one title in which you have previous work experience.


If not on the list, please specify:


Years of related working experience

Dates worked Type of Work (describe) Occupation Title


Relatives in Canada

Are any of your relatives citizens or permanent residents of Canada?
None Spouse Child Father Mother Sister Brother Aunt Uncle Niece Nephew Grandparent Grandchild


Do you have close friends in Canada who will offer to give you settlement assistance ? No Yes


Do you have any concrete employment prospects in Canada? No Yes


Family

Spouse's First Name:
Spouse's Last Name:
Spouse's age:


Spouse's Language Ability:
English:Read
Write
Speak
Comprehend
French:Read
Write
Speak
Comprehend


Spouse's Education:
Spouse's Occupation:
Number of Children:
Their Ages:



Financial Resouces

How much cash or liquid financial resources (in US Dollars) do you have available to transfer to Canada?        


Address

E-Mail address:
Postal Address:
Phone Number:
Fax Number:



Additional Comments or Questions:

Please use the space below to provide any additonal information or ask any questions you may have about immigration to Canada.

Please indicate how you prefer us to contact you:
E-Mail Post Mail Fax


           

Canadian Immigration Law Firm of Lorne Lichtenstein
lawyer@canada-da.com
2000-2014

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