Clark Wilson LLP
Canadian Immigration Assessment Form

After completing the following form to the best of your ability, press the SUBMIT button to  send to Clark Wilson LLP. You may also print this form and fax or mail it to us. We will then contact you to arrange an appointment in person or by phone to review your information and advise you of your prospects for immigration to Canada and of the best method to achieve your goal. 

How did you learn about Clark Wilson LLP?
Friend/Relative  Agent  Advertisement
Lawyer Search Engine Link
Other, please specify: 

Objective

Briefly Describe how we can assist you:



Bio Data

Family Name: 
First Name:
Middle Name: 
Other Names Used:
Sex:  Male Female
Age: 
Date of Birth: (Day/Month/Year)
City & Country of Birth:
Social Insurance Number: 

 Marital Status:
Never Married Married Divorced Separated Widowed
Please Provide Spouse's full name:

* If married, have your spouse complete an additional Assessment Form.

 Address (both within and outside Canada):

Home TEL:  FAX:
Work TEL: E-mail: 
Country(ies) of Citizenship:

Please provide the full name, city and country of birth,
and birthdate of each of your children:


RELATIVES IN CANADA:
Please list at least three of your
closest relatives in Canada (if 
any) and state their relationship
to you, their immigration or citizen
status, their address and phone
number:




Visa & Passport
APPLICANT'S VISAS
Current Visa 
Held Country:
Date Admitted:
Visa Expiry Date:
Previous Visa Held:
Date Admitted:
Visa Expiry Date:
APPLICANT'S PASSPORT
Issued By (Country):
Issue Date:
Expiry Date:
Passport Number:

Have you ever applied for Canadian Landed Immigrant Status? Yes No

Grounds for Citizenship

YOU MAY ALREADY BE A CITIZEN

Do you have a parent or grandparent who was born in or is a citizen of Canada? Yes No
 

DO YOU QUALIFY UNDER ANY OF CANADA'S
BUSINESS IMMIGRANTS CATEGORIES?

a) Investor
I have successfully operated, controlled or directed a business and have a net worth, accumulated by my own endeavours, of at least CAD $800,000.  Yes No

b) Entrepreneur

I intend and have the ability (shown by past business success) to establish, purchase or invest substantially in a business or commercial venture in Canada that will contribute significantly to the economy and create jobs employing at least one Canadian citizen or permanent resident other than myself and my dependants. Yes No

c) Self-employed

I am self-employed (i.e. professional athlete, artist, actor, farmer, writer, etc.) and can establish or purchase a business in Canada that will employ me and contribute significantly to Canada's economy or cultural or artisitic life. Yes No


DO YOU QUALIFY ON THE BASIS OF YOUR
OCCUPATIONAL SKILLS AND TRAINING?

Have you located an employer in Canada who is willing to employ you? Yes No

LIST YOUR PRESENT AND PREVIOUS EMPLOYERS
STARTING WITH THE MOST RECENT:
A. Present or Most Recent Employer
Name of Employer
Title/Position
Number of years worked
Description of duties
B. Previous Employer
Name of Employer
Title/Position
Number of years worked
Description of duties
C. Previous Employer
Name of Employer
Title/Position
Number of years worked
Description of duties


Education
INDICATE LEVELS OF EDUCATION COMPLETED:
years Primary/Elementary
years Secondary/High School
years of Vocational Commercial Technical Training
years of University College Other

Please provide details of any other training or education:


Please list all degrees and diplomas obtained from educational institutions:


LANGUAGE ABILITY:
ENGLISH:
SPEAK Fluent Functional With Difficulty None
READ Fluent Functional With Difficulty None
WRITE Fluent Functional With Difficulty None
FRENCH:
SPEAK Fluent Functional With Difficulty None
READ Fluent Functional With Difficulty None
WRITE Fluent Functional With Difficulty None

Is there anything else that you believe may be relevant to your application?
Please include any questions or comments you may have.

PLEASE READ THE FOLLOWING STATEMENTS AND INDICATE YOUR
ACCEPTANCE OF THESE TERMS PRIOR TO SUBMITTING THIS FORM
 I have prepared the answers to these questions to the best of my ability and I believe them to be truthful and correct. 
I understand that the submission of this form does not create any obligation for myself or for the lawyer with whom I wish to request a formal consultation. I further understand that submission of this form does not create an solicitor-client relationship and that the lawyer is not obliged to schedule a consultation with me.


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