Fill out the following questionnaire and, when you are finished, click submit to send to CIS Consultants Inc for a free immigration evaluation.
   

PERSONAL
INFORMATION

Family Name:
Given Name(s):
What is your gender/sex?
Age:
City of Residence:
Full Mailing Address:
Telephone (work):
Telephone (home):
Fax:
Email:
 
Indicate only mailing address, email address, telephone and telefax numbers where it is acceptable to contact you directly.
 

 
Citizenship:
Country of permanent residence:
Marital status:  single married engaged divorced
Name of Spouse:
Highest degree obtained by Spouse:
Occupation of spouse:
Number of children:

EDUCATION

When describing your education, please indicate the full name of any degrees that you have obtained (for example, "Bachelor of Science" or "Bachelor of Engineering" and not simply "Bachelor")
   

Most Recent Degree or Diploma:
Have you received your Title for this degree?:
Number of fulltime years of study:
Name of University or College:
Previous Degree(s) or Diploma(s):
Have you received your Title for this degree?:
Number of fulltime years of study:
Name of University or College:
Other Degree(s) or Diploma(s):
Have you received your Title for this degree?:
Number of fulltime years of study:
Name of University or College:

  LANGUAGES

   
Speak English
Speak French
Listen English
Listen French
Read English
Read French
Write English
Write French
ASSETS

Total Value of Cash and Property (please estimate in U.S. dollars, even if the asset in not presently in U.S. dollars):

EMPLOYMENT

   
   
Employer/Company:
Title/Position:
From:(month/year)
To:(month/year)
Describe duties in detail:
   
Employer/Company:
Title/Position:
From:(month/year)
To:(month/year)
Describe duties in detail:
   
Employer/Company:
Title/Position:
From:(month/year)
To:(month/year)
Describe duties in detail:
   
Employer/Company:
Title/Position:
From:(month/year)
To:(month/year)
Describe duties in detail:
   
Employer/Company:
Title/Position:
From:(month/year)
To:(month/year)
Describe duties in detail:
   
Licenses, professional designations, or memberships:

ADDITIONAL INFORMATION

   
Do you or any family members have any medical problems?  Yes No
Have you or any family members ever been charged or convicted of any offence?  Yes No
Have you or any family members ever applied for Canadian Residence?  Yes No
Have you ever visited Canada?  Yes No
Do you, or your spouse, have at least one of the following family members living in Canada?
Have you ever been refused admission or ordered to leave Canada?  Yes No
Have you ever made a refugee claim in any country?  Yes No
Do you have political hardship, refugee concerns, or other hardships in your country?  Yes No
Additional information:

I certify that the above information is truthful, complete, and correct.  Yes No

How did you hear about CIS Consultants Inc.?

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