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ACTLAP IMMIGRANT Assessment Form

Fill in the information below to get your qualification assessed.

Personal Details

* Full Name

Sex

Date of Birth

Residential Address

Street Address

City
State
Zip/Postal Code
Country
Resident for how long?
Country of Citizenship (How Long):
Mailing Address
Street Address
City
State
Zip/Postal Code
Country
Home Phone
Work Phone
Cell/Mobile Phone

* Email Address

Fax
Please ensure that this email is active and valid as your assessment result will be sent to this address only.
Family Details
Current Marital Status:
Children (Total number of)
Age Level of Education Country of Citizenship
1
2
3
4
5
Education
Total Years of Formal Education: (including Primary Education)
Level of Education (indicate whether full/part time) Duration From – To
(MM – YY) (MM – YY)
Name of Institution City/Town and Country Degree/Diploma/Certificate/ Apprenticeship Issued
Work History
Please indicate work history of the past 10 years. Kindly attach Resume /CV to this form.
From(mm/yy) To(mm/yy) Company Name Detailed Job Duties Job Title
Language Proficiency
English
Speak
Write
Read
Listen
French
Speak
Write
Read
Listen
Have you done the IELTS (English Language Test)?
If yes, General or Academic:
Result
Listening
Speaking
Reading
Writing
Overall Score:
When the test was taken (MM/YYYY):
Information on Applicant’s Husband or Wife (Please write in full):
A Education: Total Years of Formal Education: (including Primary Education)
Level of Education (indicate whether full/part time) Duration From – To
(MM – YY) (MM – YY)
Name of Institution City/Town and Country Degree/Diploma/Certificate/ Apprenticeship Issued
B) Work History - Please indicate work history of the past 10 years. Kindly attach Resume /CV to this form.
From(mm/yy) To(mm/yy) Company Name Detailed Job Duties Job Title
Do you have any relative in Canada?
If yes, indicate…
Name of Relative:
Relationship:
Legal Status of relative in respective country:
Did you attend secondary or post secondary school in Canada?
If yes, indicate…
Total Years of Formal Education:
Level of Education (indicate whether full/part time) Duration From – To
(MM – YY) (MM – YY)
Name of Institution City/Town and Country Degree/Diploma/Certificate/ Apprenticeship Issued
Have you worked in Canada, on a work permit, for at least 1 year?
If yes, indicate…
Duration
From(mm/yy) To(mm/yy) Company Name Detailed Job Duties Job Title
Do you have a confirmed job offer from an employer in Canada?
If yes, indicate…
Company Name and Location
(City , State,Country)
Detailed Job Duties Job Title
Financial Information (in Canadian Dollars)
Total Monthly Income
(You and your spouce)
Total Savings
(Banks and other Investments)
Total Networth of your family
(i.e. Assets, Stocks, Real Estate etc)
Do you have any serious medical, mental or physical disorder?
If Yes, give details
Additional Information: Please attach any additional information you think may be important to access your eligibility.
Please attach a copy of your most recent resume to this application.
DECLARATION: I hereby declare that the information given in this assessment form is true to the best of my knowledge and belief. I understand that Highground Immigration Services Inc. can use this information to contact me via all modes of communication and send information as required. If this form is sent by email, I hereby state that this information has been sent with my prior consent and approval.