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Home
Our Services
Shirah Migration
Permanent Residency
Study
Work Permit
Visit Canada
Business Migration
Customized Tours
About Us
Blog
News
Contact Us
Questionnaire
ASSESSMENT FORM
Please enable JavaScript in your browser to complete this form.
Title
Mr
Mrs
Ms
Dr
Name
*
First
Last
Sex
Male
Female
Country
Street Address
*
City
State/Province/County
Postcode
*
Home phone
*
Mobile phone
*
Email
*
Date of Birth
City & Country of Birth
Nationality
Occupation
Your current residence status
Citizen/Permanent Resident/On Temporary Visa
Other citizenships?
(if applicable)
Have you lived outside your current country of residence for any periods of 12 months or more?
*
Yes
No
If yes state County & Period of Stay
COUNTRY & YEAR
Have you ever lived or worked in Canada?
*
Yes
No
If yes state Date & Details
DATES OF WORK AND JOB DETAILS
Have you ever visited Canada?
*
Yes
No
If yes state Date & Details
DATES & DETAILS
Which province or territory do you plan to live in?
*
Which language test did you take for your first official language?
IELTS (English)
CELPIP (English)
TEF (French)
Not yet taken
What date did you take this test?
mm/dd/yy
Enter the test score for Speaking:
Enter the test score for Listening:
Enter the test score for Reading:
Enter the test score for Writing:
Which language test did you take for your second official language?
IELTS (English)
CELPIP (English)
TEF (French)
What date did you take this test?
mm/dd/yy
Enter the test score for Speaking:
Enter the test score for Listening:
Enter the test score for Reading:
Enter the test score for Writing:
Marital Status
Single
Married
De Facto (Living together)
Same sex relationship
Divorced
Seperated
Widow(er)
Does your spouse or partner plan to come with you to Canada?
Yes
No
Is your spouse or partner a citizen or permanent resident of Canada
Yes
No
Has your spouse or partner studied in Canada full-time for two years or more?
Yes
No
Has your spouse or partner worked in Canada full-time for one year or more?
Yes
No
Has your spouse or partner taken an English or French language test?
IELTS (English)
CELPIP (English)
TEF (English)
What date did they take this test?
mm/dd/yy
Enter the test score for Speaking:
Enter the test score for Listening:
Enter the test score for Reading:
Enter the test score for Writing:
In the last three years, how many years of skilled work experience do you have in Canada?
It must have been full-time (or an equal amount in part time).
During this period, which National Occupation Classification (NOC) level is most of the experience in?
NOC Skill Type A (Professional jobs)
NOC Skill Type B (Technical jobs and Skilled Trades/Manual work)
NOC Skill Level 0 (Managerial jobs)
None of the Above
If you do not have any Canadian work experience during this period, please choose "None of the above".
In the last 10 years, how many years of skilled work experience do you have?
It must have been continuous, paid, full-time (or an equal amount in part-time), and in only one occupation.
In the last five years, do you have at least two years of experience in one of these types of jobs (skilled trades)?
Industrial, electrical and construction trades (NOC codes that start in 72)
Maintenance and equipment operation trades (NOC codes that start in 73)
Supervisors and technical jobs in natural resources, agriculture and related production (NOC codes that start in 82)
Processing, manufacturing and utilities supervisors and central control operators (NOC codes that start in 92)
Chefs and cooks or (NOC codes that start in 632)
Butchers and bakers (NOC codes that start in 633)
Do you have a certificate of qualification from a Canadian province or territory in one of the 3 Preliminary Eligibility Assessment (PEA) Form – January ‘19 skilled trade groups listed above?
Yes
No
Do you have a valid job offer in Canada?
Yes
No
Are you currently working legally in Canada?
Yes
No
What is the highest level of education for which you have earned a Canadian degree, diploma or certificate, or have had an Educational Credential Assessment?
Certificate
Diploma
Bachelor Degree
Masters
Doctorate
How many family members do you have?
I have studied full-time in Canada for two years or more
Yes
No
I have at least two years of full-time work experience in Canada
Yes
No
(the job must have been NOC Skill Type 0 or Skill Level A or B).
I have a relative in Canada who is 18 years or older, a citizen or permanent resident of Canada, and is my parent, child, grandparent, grandchild, sibling, aunt, uncle, niece or nephew.
Yes
No
If yes Please specify relationship and what province they reside.
Do you or any of those accompanying you have any health problems or chronic illnesses?
Yes
No
If so, please give details:
Have you applied directly to a province or territory and have been considered under its Provincial Nominee Program (PNP)?
Yes
No
Is there any further important information that should be known about you 5 Preliminary Eligibility Assessment (PEA) Form – January ‘19 that may affect your application? (Please continue on separate sheet if necessary)
Accept
I hereby state that the information contained in this form is, to the best of my knowledge an accurate and truthful statement of my past and current situation.
Name
Submit
