Initial Client Assessment for Travel and Immigration · Skype ID WhatsApp Viber WeChat Your current...

ACENAS Immigration

Regulated Canadian Immigration Consultant/Consultant réglementé en immigration canadienne No. R516822

Office: 1200, rue Saint Alexandre, Suite 312 Montréal, Québec, Canada H3B 3H5

Tel.: (514) 969 7343 | Fax: (514) 969 6545

E-mail: [email protected]

Initial Client Assessment for Travel and Immigration

Reserved for Official Use of the Immigration Consultant Only

File No.

Assessment Date Consultation Date

Retention Date Follow-up Date

The information in this questionnaire will be used for the purpose of providing written recommendations regarding

visiting or immigrating to Canada. The answers will help us understand the reason for your inquiry.

Important:

Should a question do not apply to you, DO NOT leave it blank. Instead, write NOT APPLICABLE or N/A.

1- Personal information

Family Name First Name Middle/Maiden Sex (M/F)

Date of Birth (dd-mm-yyyy) Place of Birth (City, Country) Citizenship(s)

Passport No. Country of issue Expiry date

Current residence (City, Country) No. of years stayed Your current occupation

Methods of communication

E-mail address Telephone no. (Country code - area code - no.)

Skype ID WhatsApp Viber WeChat

Your current marital status (please indicate since when you are under this status)

Single Single with dependent

Common-law Married Divorced Widowed

What is/are your plans coming into Canada? (i.e., refugee claim, studies, live permanently, work, visit, health, etc.)

Client Initial Client Assessment P a g e | 2

** Members of ICCRC – E-mail: [email protected] • Tel.: 1-877-836-7543 5500 North Service Road, Suite 1002, Burlington, Ontario, Canada L7L 6W6

2- Education

Number of years of education in total: (primary/elementary, high school/secondary, college, university)

Kindly tick (✓) as applies to your highest level of completed education

PhD (Doctoral Level) (i.e. PhD in Biochemistry)

Master's Level or Professional Degree (i.e. Master of Business Administration)

Two or more post-secondary credentials, one of which is a three-year or longer post-secondary credential (i.e. 4-Year Bachelor of Science AND 3-Year Culinary Diploma)

Only one three-year or longer post-secondary credential (i.e. 3-Year Bachelor of Science OR 4-Year Hospitality Diploma)

Two-year post-secondary credential (i.e. 2-Year Diploma in Informatics)

One-year post-secondary credential (i.e. 1-Year Certificate in Hospitality)

Secondary/High School educational credential (i.e. Secondary/High School Diploma)

Exact title or details of Highest Qualification Received (Last completed degree received)

3- Employment history

Please indicate the PAID FULL-TIME work experience within the past ten (10) years ONLY (Full-Time work is 30 hours per week, or the equivalent thereof)

From

YYYY-MM

To

YYYY-MM

Job Title Job Description Company Name Country

Additional information: certifications, professional development courses



4- Language proficiency

Your current level of English and/or French (please indicate your level according to the definitions)

Advanced: Can clearly and spontaneously express his/her opinion on a wide variety of subjects

Intermediate: Can express his opinion and communicate effectively in familiar social situations regularly encountered in work, school, leisure, etc.

Basic: Can understand and use familiar everyday expressions and very basic phrases. Can communicate in simple and routine tasks requiring a direct exchange of information on familiar and routine matters.

None: Can not communicate.

ENGLISH Speaking Listening Reading Writing

FRENCH Speaking Listening Reading Writing

Have you taken any formal test for English* and/or French**? If yes, please answer the following questions. (*CELPIP: Canadian English Language Proficiency Index Program, IELTS: International English Language

Testing System,**TEF: Test d’évaluation de français)

Which test? General or academic?

When? Score for Speaking

Score for Listening

Score for Reading

Score for Writing

5- Your spouse/partner and children

Do you have a Spouse/Common-Law Partner/Same-Sex Partner? (Yes/No)

If YES, since when? (dd, mm, yyyy), If NO, N/A.

Is your spouse/partner immigrating with you to Canada? (Yes/No)

If NO, why? If YES, N/A.

Have you previously been married or in a common-law relationship? (Yes/No)

If YES, when? If NO, N/A.

http://www.celpiptest.ca/

http://www.ielts.org/




Spouse/Partner personal information

Family Name First Name Middle/Maiden Sex (M/F)

Date of Birth (dd-mm-yyyy) Place of Birth (City, Country) Citizenship(s)

Passport No. Country of issue Expiry date

Current residence (City, Country) No. of years stayed Your current occupation

Methods of communication

E-mail address Telephone no. (Country code - area code - no.)

Skype ID WhatsApp Viber WeChat

Spouse/Partner education

Number of years of education in total: (primary/elementary, high school/secondary, college, university)

Kindly tick (✓) as applies to your highest level of completed education

PhD (Doctoral Level) (i.e. PhD in Biochemistry)

Master's Level or Professional Degree (i.e. Master of Business Administration)

Two or more post-secondary credentials, one of which is a three-year or longer post-secondary credential (i.e. 4-Year Bachelor of Science AND 3-Year Culinary Diploma)

Only one three-year or longer post-secondary credential (i.e. 3-Year Bachelor of Science OR 4-Year Hospitality Diploma)

Two-year post-secondary credential (i.e. 2-Year Diploma in Informatics)

One-year post-secondary credential (i.e. 1-Year Certificate in Hospitality)

Secondary/High School educational credential (i.e. Secondary/High School Diploma)

Exact title or details of Highest Qualification Received (Last completed degree received)

Spouse/Partner employment history

Please indicate the PAID FULL-TIME work experience within the past ten (10) years ONLY (Full-Time work is 30 hours per week, or the equivalent thereof)

From

YYYY-MM

To

YYYY-MM

Job Title Job Description Company Name Country



Additional information: certifications, professional development courses

Spouse/Partner language proficiency

Current level of English and/or French or your spouse/ partner (please indicate your level according to the

definitions)

Advanced: Can clearly and spontaneously express his/her opinion on a wide variety of subjects

Intermediate: Can express his opinion and communicate effectively in familiar social situations regularly encountered in work, school, leisure, etc.

Basic: Can understand and use familiar everyday expressions and very basic phrases. Can communicate in simple and routine tasks requiring a direct exchange of information on familiar and routine matters.

None: Can not communicate.

ENGLISH Speaking Listening Reading Writing

FRENCH Speaking Listening Reading Writing

Has your spouse/partner taken any formal test for English* and/or French**? If yes, please answer the following questions. (*CELPIP: Canadian English Language Proficiency Index Program, IELTS: International English

Language Testing System,**TEF: Test d’évaluation de français)

Which test? General or academic?

When? Score for Speaking

Score for Listening

Score for Reading

Score for Writing

Children

Do you have any children, including step children and children of your spouse/common-law partner? If yes, please provide the following information. If No, N/A.

Family name Given name Birth date (dd-mm-yyyy) Age

http://www.celpiptest.ca/





6- Financial information

Are you able to pay for your travel/immigration to Canada? (Yes/No)

Are you able to show proof of funds for travel/immigration to Canada? (Yes/No)

Indicate here your personal net worth in Canadian Dollars. To calculate your total personal net worth, you must do the following: 1. List all of your fixed assets, such as real estate and cars, at their current value. 2. List all of your liquid assets: cash, certificates of deposit, stocks, bonds and bank accounts. 3. List all jewelry, furniture and household items at their current value. 4. Add all of the above. These are your total assets. 5. Subtract all of your debts, such as your mortgage, car loan and credit card balances, from your total assets.

Your liquid assets (2) = Proof of funds for application (Do not use commas, space or decimal point, e.g. 10000)

CANADIAN $

DO THIS: (1 + 2 + 3) - (5) = your total personal net worth. (Do not use commas, space or decimal point, e.g. 10000)

CANADIAN $

7- General background information

Have you traveled, stayed, studied, lived or worked for more than six (6) months in a country, other than your country of nationality? If yes, please provide the following information including the one concerning your country of origin.

Ex. A Singaporean National 1989-01 2012-04 Singapore, Singapore Live, study, work None – Singaporean Citizen 2012-04 2016-04 Montreal, Canada Study Temporary Resident Visa -Student

From YYYY-MM

To YYYY-MM

City and Country Reason for Stay Visa Issued

In which province/city in Canada would you like to live and why?

Do you have family ties in Canada? If yes, please specify the nature of the relationship (i.e.: parents, uncle)

Do you have friends in Canada?

Have you, or your spouse/partner, ever owned a business or a farm or percentage of a business within the past five (5) years? If yes, specify where and when.

Are you an artist, performer, or involved in cultural activities at world-class level? If yes, specify where and when.

Are you an athlete of any globally recognized sports? If yes, specify where and when.

Are you self-employed in cultural activities or athletics? If yes, specify where and when.

Have you, or your spouse/partner, been a nanny (child care provider) or a caregiver? If yes, please specify which one, when and where.



8- Arranged Settlement (Kindly tick (✓) as applies to your answer)

Do you, and/or your Spouse/Partner, have: Yes No

worked in / studied in / visited Canada?

had a work or study permit to Canada?

ever lived in Canada before? If yes, specify the dates. From - - to - -

a minimum of 1 year of full-time (30 hours per week, or the equivalent thereof) authorized work experience in Canada in a managerial/professional/technical occupation or in a skilled trade?

a minimum of 2 years or more full-time (15 hours per week, or the equivalent thereof) previous authorized studies in Canada in a program of at least 2 years in duration?

a job offer for permanent / indeterminate employment in a managerial / professional / technical occupation or in a skilled trade from a prospective or existing Canadian employer AND a positive or neutral Labour Market Impact Assessment from Employment and Social Development Canada (ESDC)?

a job offer for permanent / indeterminate employment in a managerial / professional / technical occupation or in a skilled trade from a prospective or existing Canadian employer AND are exempt from a Labour Market Impact Assessment because of NAFTA/GATS, etc.?

a living relative in Canada, age 18 or over, who is a Canadian Citizen or Permanent Resident AND closer in relationship than a cousin (parents, siblings, grandparents, nephews, niece)? If yes, please specify where:

9- Miscellaneous Questions (Kindly tick (✓) as applies to your answer)

Do you, your Spouse/Partner, and/or your dependents have: Yes No

had any serious disease or physical or mental disorder?

been convicted of or are currently charged with any crime or offence in any country?

applied previously for temporary status in Canada (i.e. visitor/student/worker)?

been refused a Canadian Permanent visa/Temporary Resident (Visitor) Visa / Study Permit / Work Permit, or that of any other country?

been refused admission to, or ordered to leave Canada, or any other country?

been involved in the commission of a war crime or a crime against humanity?

applied previously for permanent status in Canada?

been convicted of, or is the Applicant currently charged with, on trial for, or party to a crime or offence, or subject of any criminal proceedings in any country?

been detained in any country or put in jail?

If you answered YES to any questions above/previously, please provide details, below:



10- About Acenas Immigration

Are we the first consultant you have consulted regarding immigration?

If No, who did you consult and why did not you hire their services?

Do you have any EXISTING contract or obligation with a consultant / lawyer regarding immigration?

How did you learn of our firm, Acenas Immigration?

A friend (who)

Online (which

website/s)

Consultant Referral (who)

Former/ present client

(who)

Magazine (which one)

Other (specify)

PLEASE READ CAREFULLY AND SIGN BELOW

An initial consultation may be scheduled following this assessment should you need to talk with a consultant. You will be asked to pay CA$50 for your initial consultation only. Following your initial consultation, if you agree to hire the Consultant, and the Consultant agrees to represent you, you will both sign a Retainer Agreement for Representation. The Retainer Agreement for Representation will set forth the terms and conditions of representation. Kindly attach the scanned/copies of the following documents with this form upon submission to us:

Valid passport

Birth certificate (with certified translation, if it is not in English or French)

School credentials (with certified translation, if it is not in English or French)

Entry/exit visa (for each country lived/worked/visited)

Language test result in English or French (IELTS or TEF)

Work Experience certificates (with certified translation, if it is not in English or French)

Marriage certificate, if married (with certified translation, if it is not in English or French)

Children’s birth certificates, if any (with certified translation, if it is not in English or French) Your signature acknowledges only that you have received this information sheet free of charge; that you have read this information sheet; that you have completed this information sheet to the best of your ability; that you understood that the initial assessment receipt and completion by you of this information sheet DOES NOT mean you have hired this FIRM.

Signature:

Date (Day, Month, Year):

Printed Full Name: ___________________________________________________

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