Immigration (Skilled Worker) Contact Form

1) Family Name(s):

2) Given Name(s):

3) Gender:

Male Female

5) Date of Birth:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December

5) Email Address:

6) Your citizenship:

7) Current place of residence:

8) Your current status in that location:

Citizen Permanent Resident Being sponsored by family member Work visa holder Student visa holder Visitor visa holder I had legal status but my permit or visa expired I entered without legal status and still have none Recognized refugee or protected person Refugee or asylum claimant I am not sure of my status

9) Provide an honest self-assessment of your ability in each of Canada’s official languages, English and French.

For each heading please choose among the following numbers to describe your abilities:

4 = High;   3 = Moderate;   2 = Basic;   1 = Not at all

English –

Speak: 1 2 3 4   Write:  1 2 3 4   Read: 1 2 3 4   Understand: 1 2 3 4

French –

Speak: 1 2 3 4   Write:  1 2 3 4   Read: 1 2 3 4 Understand: 1 2 3 4

10) What is the highest level of formal studies completed by you?

Post-graduate: doctorate, master’s Professional: lawyer, engineer, medical doctor, etc. University: first-level university degree College: diploma Certificate: specialized studies certificate High School: completed

Please list your degrees / diplomas, name and place of school, year obtained, and specialty (example, business administration) here.

11) Number of years of formal education beginning with grade 1:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

12) Please describe your work history.  Type or paste your short-form curriculum vitae / résumé here. If you have never worked, please state "no employment history".

13) Are you married or in a common-law relationship?

Yes No

14)Do you have any dependent children?  If yes, how many?

No 1 2 3 4 5 6 7 8 9 10

15) If you have any questions or comments, please type them here.

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