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PERSONAL INFORMATION
Salutation
Family/Given Name
Date of Birth:
Country of Current Permanent or Long-Term Residence
Citizenship
CONTACT INFORMATION
Tel
Fax
E-mail
Address
Name of Your Spouse (if any)
Spouse Date of Birth
Age of Oldest Child (if applicable)
Number of children under 19
YOUR EDUCATION
What is the highest education credential you have obtained, and how long was the course of study or training? 
How many years of total education was required to complete the education credential?
If you have a Bachelor degree, do you also have a second Bachelor degree?  Yes No
YOUR SPOUSE'S EDUCATION
Spouse's highest education credential.
How many total years of education?
YOUR CURRENT OCCUPATION
Describe your current occupation
How long have you worked in your current occupation?
Have you worked in any other occupation in the past ten years? If so, please describe
SPOUSE'S OCCUPATION
What is your spouse's current occupation (if any)?
How long has your spouse worked in that occupation?
Has your spouse worked in any other occupation in the last ten years? If so, please describe.
LANGUAGE SKILLS
Describe your ability to speak, read, listen and write English
High Proficiency
Moderate Proficiency
Basic Proficiency
Not at all
Describe your ability to speak, read, listen and write French
High Proficiency
Moderate Proficiency
Basic Proficiency
Not at all
If married, describe your spouse's ability to speak, read, listen and write English
High Proficiency
Moderate Proficiency
Basic Proficiency
Not at all
Describe your spouse's ability to speak, read, listen and write French
High Proficiency
Moderate Proficiency
Basic Proficiency
Not at all
ARRANGED EMPLOYMENT / EMPLOYMENT PROSPECTS
Do you or your spouse have a confirmed offer of permanent employment in Canada at this time? If yes, please describe Yes No
If no, do you have any definite prospects for employment in Canada at this time?  Yes No
If yes, please describe
If you have neither a confirmed offer of employment nor definite employment prospects, at this time, what are your reasons for believing that you will become economically successful in Canada?
RELATIVE LIVING IN CANADA
Do you, or your spouse, have any blood relatives living in Canada, who are either Permanent Residents or Canadian Citizens, of the following types: brother, sister, aunt, uncle, niece, nephew, father, mother, spouse or child? Yes No
If yes, describe the relationship to you?
If not, are there other more distant relations or close friends living in Canada who would be prepared to offer assistance to you? If yes, please explain
ABILITY TO SETTLE IN CANADA
Canada requires applicants to be able to transfer a minimum amount of money to Canada upon immigration. This amount is CAD$ 10,000 for the principal applicant, plus CAD$ 2000 for each accompanying dependent. Will you be able to transfer such an amount to Canada?  Yes No
MOTIVATION FOR MOVING TO CANADA
Please describe why you want to immigrate to Canada
CURRICULUM VITAE

 
In addition to completing this form You may also send your CV to
awlodyka@axionet.com.

Have you or any of your family members ever had any problems with police? If yes, please advise.

Have you or any of your family members ever have any serious medical problems? If yes, please advise.

Thank you for completing my Personal Data Form. I will respond to you shortly with my preliminary assessment of your chances.



Copyright © 2003 Andrew Wlodyka.