Name:
  Email:
  From:
  Email:
   
     
 
APPLICATION FOR FREE ASSESSMENT
(For Professionals & Skilled Workers-Independent Class)

(CONFIDENTIAL WHEN FILLED)
Please answer all questions carefully either in block letters or use typewriter. If space is insufficient continue you answer on a separate sheet. Please ensure that you attach a detailed Resume with this application. Please complete applicable Sections.
Section A – Information about yourself
Section B – Information about spouse
Section C – Information about children

SECTION A
(To be completed by applicant)
 Last Name :
 Given Name :
 Sex :
 Date of Birth :
 Place of Birth :
 Country of Birth :
 Citizenship :
 Permanent Address :
 Phone :
 Email Address :
 Marital Status :
       
Do you or your spouse have relatives in Canada (Spouse, Fiancé (e), Partner, Parents, Grandparents, Grandchildren, Brother, Sister, Nephew, Niece, Uncle and Aunt). If yes, please give details:
 Name :  Relationship :
 Phone :  Email Address :
 Address :
Status in Canada :
 
Please provide details of your post secondary education (academic, professional or technical) from matric/secondary school onwards with dates, names and addresses of Institutions attended, courses taken and degree/diploma/certificate received. Indicate all full time and part time courses. Please do not use abbreviations.
From : Month : Year :  
To : Month : Year :  
Names of Institutions :  
Address of Institutions :  
Courses Taken :  
Diploma/Degree/Certificate :  
Full/Part time/Correspondence :  
 
Please provide detailed employment record with dates, names & addresses of employers and job designations held:
From : Month : Year :  
To Month : Year :  
Names of Employers :  
Job Designations :  
Full/Part time :  
Address of Employer :  
 
Please give detailed description of job responsibilities you performed since you started working. Please describe the job responsibilities that you performed on day-to-day basis (you may attach a separate sheet):
 
Language Ability
English
Read
Write
Speak
Listen
   
French
Read
Write
Speak
Listen
 
Have you ever visited abroad?
If yes, what all cities & countries:
 Duration :
 From :
 To :
 For which countries do you have valid visitor visas?
 
Did you or your spouse ever completed one year or more full-time work experience in Canada, with an Employment Authorization? If yes, please complete following information :
Name of Employer :  
Occupation/Designation :  
Duration of Employment : CC        CC
Phone No.  
Address :  
 
Did you or your spouse ever completed minimum of two years of full time post secondary study in Canada, with Student Authorization? If yes, please complete following information :
Name of Educational Institute :  
Name of The Course Attended :  
Duration of Course : CC        CC
Phone No.  
Address :  
 
Do you or your spouse have an offer of employment from a Canadian employer, which would be effective upon your arrival in Canada? If yes, please complete following information:
Name of Employer :  
Job/Designation Offered :  
Phone :  
Address :  
 
Do you or your spouse have Arranged Employment in Canada approved by Human Resources Development Canada? If yes, please complete following information:
Name of Employer :  
Job/Designation Offered :  
Start Date & End Date : CC        CC
Phone :  
Address :  
Your current monthly income:  
 
Do you or any of your dependents (i.e. spouse and children) have any serious medical conditions? If yes, please state name of the person and give brief detail:
How did you come to know about us (Khan Khokhar)
 
SECTION B
(To be completed for your spouse)
Last Name:  
Given Name  
Sex:  
Date of Birth :
Place of Birth :  
Country of Birth :  
Citizenship :  
Has he/she been married more than once?   
If yes, state number of times:  
 
Please provide details of your spouse’s post secondary education (professional or technical) from matric/secondary onwards with dates, names and addresses of institutions attended, courses taken and degree/diploma/certificate received. Indicate all full time and part time courses. Please do not use abbreviations.
From Month : Year :
To Month : Year :
Names of Institutions :  
Address of Institutions :  
Courses Taken :  
Diploma/Degree/Certificate :  
Full/Part time/Correspondence :  
 
Please provide your spouse’s detailed employment record with dates, names & addresses of employers and job designations held :
From Month : Year :
To Month : Year :
Names Of Employer :
Addresses of Employer :
Job Designation :
Full/Part time :
 
Please give detailed description of job responsibilities your spouse performed since he/she started working. Please describe the job responsibilities performed on day-to-day basis (you may attach a separate sheet):
 
Language Ability
English
Read
Write
Speak
Listen
 
French
Read
Write
Speak
Listen
 
Has your spouse ever visited abroad?
If yes, what all Cities and Countries :
Duration:
From Month : Year :
To Month : Year :
For which countries do you have valid visitor visas?
 
SECTION C
(To be completed for your children)
Provide details of all your children:
Full Name Son/Daughter Date of Birth
(c)
(c)
(c)
(c)
(c)