"" 1 Your Contact Information Immigration Assessment Form This information is provided under the terms of strict confidentiality agreements and your information will not be shared, sold or rented by other parties without your permission. First Name Last Name Email Address Telephone NationalityAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHeard Island And Mcdonald IslandsHoly See (vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsraelItalyJamaicaJapanJordanKazakstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, The Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre And MiquelonSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province Of ChinaTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.s.Wallis And FutunaWestern SaharaYemenZambiaZimbabwe Your Personal Profile Date Of Birth Marital StatusUnmarriedMarried or in a Common-Law Partnership What is your preferred destination in Canada? Please SelectI am not sureAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoryNova ScotiaNanuvatOntarioPrince Edward islandQuebecSaskatchewanYukon Do you have any Dependent Children?YesNo Your Personal Net Worth Your Personal Net Worth is the current value of all the assets (e.g. properties, investments, stocks, bonds, bank accounts) that you (and your spouse/common-law partner, if applicable) personally own, MINUS the current value of all your combined personal liabilities (e.g. mortgages, loans, credit card balances). Please be sure to include your share of the value of any businesses that you own. Choose CurrencyCanadian dollarUnited States dollarAfghaniAlbania LekAlgeria DinarAndorra EuroAngola New KwanzaAntigua and Barbuda East Caribbean dollarArgentina PesoArmenia DramAustralia Australian dollarAustria Euro (formerly schilling)Azerbaijan ManatBahamas Bahamian dollarBahrain dinarBangladesh TakaBarbados Barbados dollarBelarus Belorussian rubleBelgium Euro (formerly Belgian franc)Belize dollarBenin CFA FrancBhutan NgultrumBolivia BolivianoBosnia and Herzegovina MarkaBotswana PulaBrazil RealBrunei dollarBulgaria LevBurkina Faso CFA FrancBurundi francCambodia RielCameroon CFA FrancCape Verde Cape Verdean escudoCentral African Republic CFA FrancChad CFA FrancChile Chilean PesoChina Yuan/RenminbiColombia Colombian PesoComoros FrancCongo, Democratic Republic of the Congolese francCongo, Republic of CFA FrancCosta Rica ColónCôte d'Ivoire CFA FrancCroatia KunaCuba Cuban PesoCyprus poundCzech Republic KorunaDenmark KroneDjibouti francDominica East Caribbean dollarDominican Republic Dominican PesoEast Timor U.S. dollarEcuador U.S. dollarEgypt Egyptian poundEl Salvador Colón; U.S. dollarEquatorial Guinea CFA FrancEritrea NakfaEstonia KroonEthiopia BirrFiji dollarFinland Euro (formerly markka)France Euro (formerly French franc)Gabon CFA FrancGambia DalasiGeorgia LariGermany Euro (formerly Deutsche mark)Ghana CediGreece Euro (formerly drachma)Grenada East Caribbean dollarGuatemala QuetzalGuinea Guinean francGuinea-Bissau CFA FrancGuyana Guyanese dollarHaiti GourdeHonduras LempiraHungary ForintIceland Icelandic krónaIndia RupeeIndonesia RupiahIran RialIraq U.S. dollarIreland Euro (formerly Irish pound [punt])Israel ShekelItaly Euro (formerly lira)Jamaican dollarJapan YenJordan Jordanian dinarKazakhstan TengeKenya shillingKiribati Australian dollarKorea, North WonKorea, South WonKuwait Kuwaiti dinarKyrgyzstan SomLaos New KipLatvia LatsLebanon Lebanese poundLesotho MalutiLiberian dollarLibya Libyan dinarLiechtenstein Swiss francLithuania LitasLuxembourg Euro (formerly Luxembourg franc)Macedonia DenarMadagascar Malagasy francMalawi KwachaMalaysia RinggitMaldives RufiyaMali CFA FrancMalta Maltese liraMauritania OuguiyaMauritius Mauritian rupeeMexico Mexican pesoMoldova LeuMonaco EuroMongolia TugrikMontenegro EuroMorocco DirhamMozambique MeticalMyanmar KyatNamibia Namibian dollarNauru Australian dollarNepal Nepalese rupeeNetherlands Euro (formerly guilder)New Zealand New Zealand dollarNicaragua Gold cordobaNiger CFA FrancNigeria NairaNorway Norwegian kroneOman Omani rialPakistan rupeePalau U.S. dollar usedPalestinian State (proposed) New Israeli shekels, Jordanian dinars, U.S. dollarsPanama balboa; U.S. dollarPapua New Guinea KinaParaguay GuaraníPeru Nuevo sol (1991)Philippines PesoPoland ZlotyPortugal Euro (formerly escudo)Qatari riyalRomania LeuRussia RubleRwanda Rwanda francSt. Kitts and Nevis East Caribbean dollarSt. Lucia East Caribbean dollarSt. Vincent and the Grenadines East Caribbean dollarSamoa TalaSan Marino EuroSão Tomé and Príncipe DobraSaudi Arabia RiyalSenegal CFA FrancSerbia Yugoslav new dinar. In Kosovo both the euro and the Yugoslav dinar are legalSeychelles rupeeSierra Leone LeoneSingapore dollarSlovakia KorunaSlovenia Slovenian tolar; euro (as of 1/1/07)Islands dollarSomalia Somali shillingSouth Africa RandSpain Euro (formerly peseta)Sri Lanka Sri Lanka rupeeSudan DinarSuriname Surinamese dollarSwaziland LilangeniSweden KronaSwitzerland Swiss francSyria Syrian poundTaiwan dollarTajikistan somoniTanzanian shillingThailand bahtTogo CFA FrancTonga Pa'angaTrinidad and Tobago dollarTunisia Tunisian dinarTurkey Turkish lira (YTL)Turkmenistan ManatTuvalu Australian dollarUganda Ugandan new shillingUkraine HryvnaUnited Arab Emirates U.A.E. dirhamUnited Kingdom Pound sterling (£)Uruguay Uruguay pesoUzbekistan Uzbekistani sumVanuatu VatuVatican City (Holy See) EuroVenezuela BolivarVietnam DongWestern Sahara (proposed state) TalaYemen RialZambia KwachaZimbabw Zimbabwean dollar Net Worth ( Enter approx. value) Your Language Skills English SpeakSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All ReadSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All WriteSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All ListenSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All French SpeakSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All ReadSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All WriteSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All ListenSelect An OptionHigh/AdvanceModerate/IntermediateBasic/beginnerNot at All Your Education and Training Have you completed high school (secondary school)?YesNo Have you done any education or training other than high school (secondary school)?YesNo Your Work History Have you done any paid work during the last 10 years?YesNo Canadian Job Offer Do you have a written job offer from a Canadian employer?YesNo Do you have any family members, relatives, or close friends living in Canada?YesNo Questions and CommentsPlease use this space to send any specific questions, comments or additional information that may be relevant to your inquiry.0 / Immigration NewsletterPlease check here if you would like to receive our free electronic monthly Canadian Immigration Newsletter. 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