Questionnaire

Title

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?

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?

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:

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?

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?

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)?

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?

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.

Message

Services

Contact Us