Preliminary Evaluation Form

Please be aware that this is not an application form for Immigration Canada! This form is used to collect information for the purpose of a free preliminary evaluation to give GO KANADA some facts and history. Additional personal information will only be necessary after a contract is signed by both parties.

We assure you that all information is highly confidential and will never be sold, provided or transferred to a third-party.

Applicant’s Information

Given Name*(*fields are mandatory)
Last Name*(*fields are mandatory)
I am
The applicant Not the applicant
Gender
Female Male
Your Age
Status
Country of Birth
Country of Citizenship
Mailing Address
eMail(*correct eMail required )
eMail Confirmation(*correct eMail required )
Phone (please provide prefix if outside North America)
Fax (please provide prefix if outside North America)
How would like GO KANADA to contact you?
Phone Fax eMail

Applicant - Objectives

I would like to
I would like to work in Canada in the following occupation:
What occupation category would this occupation fit into? (Job Search|Occupations)|
Group A Group B Group C Group G Group L
I would like to work in/move to the following province: (Choose all applicable)
Do you have a work contract with a Canadian employer in Canada?
yes no
If yes, please provide details.

Language Skills – Applicant

I speak English
I speak French
My native tongue is:

Connections to Canada – Applicant

Do you have relatives living in Canada?
Yes No
If yes, please provide name, mailing address, and relationship to Applicant
Have you ever legally lived, worked or studied in Canada?
Lived Worked Studied

Educational Background – Applicant

Please provide the number of years for each level of education.
High School
College/ University
Trades/Post-Secondary Education
Was your education part-time or distance education program?
Yes No
Post-Secondary Education without Diploma or Degree
Post Bachelorate education without Master’s Degree
Journeyman
Doctorate/ PhD
Any other Certificates or Diplomas you would like to mention?
Please indicate the year you completed each.
Total years of education (including Elementary School)

Work Experience - Applicant

Please describe you most recent position in detail first. Keep going back in your work history for as long as you wish.
(min 5 years, 10 years preferred)
Positions & Tasks

Assets – Applicant

Please indicate amounts in your local currency AND Canadian Dollars.
Note: Your Total Assets = cash + investments +real estate + other assets - (less) loans and credits, obligations
Asset value in your local currency
Asset value in Canadian Dollars
Why? We are not interested in how much you can afford for your immigration process. The government will require that you have reasonable amounts of assets available to be able to support yourself for the first few months, without the help of others. Please remember that you will need food, a place to live, insurance, transportation and of course a flight ticket to get and live here.

Spouse/Family Information

Will you be moving with your spouse and family to Canada?
Yes No
Given Name (spouse)
Last Name of your spouse/partner
Gender
Female Male
Your Age
Status
Country of Birth
Country of Citizenship
Mailing Address
Spouse’s highest level of education is
Currently employed as (occupation)
Total years of education (including Elementary School)
I speak English
I speak French
My native tongue is:
Do you have relatives living in Canada?
Yes No
If yes, please provide name, mailing address, and relationship to Applicant
Have you ever legally lived, worked or studied in Canada?
Lived Worked Studied
How many dependents under the age of 21 are planning to immigrate to Canada with the applicant?
How many dependents over the age of 21 are planning to immigrate to Canada with the applicant?

Other Important Information

If the applicant or any family members ever were convicted of a crime in Canada or any other country, a future application may be affected. This also may be true if the applicant or family member s were/are presently afflicted with a serious illness.
Would/could this apply to you or any family members?
Yes No
If yes, please let us know below:
Is there anything else you would like us to know or pay special attention to?

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