Online Assessment (Business Class – Quebec) Please follow the instructions carefully in order for us to provide you with an accurate assessment. Fields marked with * are required. Personal Details Please provide us with your name and address information. Salutation Mr.Ms.Mrs.Dr. *First Name Middle Name *Last Name Gender MaleFemale *Date of Birth JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Marital Status Never MarriedMarriedWidowedLegally SeparatedAnnulled MarriageDivorcedCommon Law *Country of Citizenship ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe Personal Details Correspondence Details *Mailing Address *City State/Province *Country ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe Postal Code Residential AddressLeave blank if same as above *City State/Province *Country ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe Postal Code Legal Statusin country of residence CitizenPermanent ResidentTemporary WorkerStudentOther Home Phone Ctry Code-Area Code-Phone No. - - Other Phone Ctry Code-Area Code-Phone No. - - Cell Phone Ctry Code-Area Code-Phone No. - Fax Ctry Code-Area Code-Phone No. - - Fax - - Email Re-enter Email Please ensure this email is active and valid as your assessment result will be sent on this address. [cf7mls_step step-1 "Next"] Immigration Specific Details Your assessment is based on your education and work details as well. Highest level of completed education Secondary school general diplomaSecondary school vocational diplomaPostsecondary school general diploma attesting to 2 yr of full-time studiesPostsecondary school technical diploma attesting to 1 yr of full-time studiesPostsecondary school technical diploma attesting to 2 yr of full-time studiesSecondary school vocational diploma or postsecondary school technical diploma attesting to 1 or 2 yr of full-time studiesPostsecondary school technical diploma attesting to 3 yr of full-time studiesUndergraduate diploma attesting to 1 yr of full-time studiesUndergraduate diploma attesting to 2 yr of full-time studiesUndergraduate diploma attesting to 3 or more yr of full-time studiesMaster's degree attesting to 1 or more yr of full-time studiesDoctorateNone of the above Was above diploma issued by a Quebec institution? NoYes Experience in the operation of an enterprise of the entrepreneur Less than 2 years2 to less than 3 years3 to less than 4 years4 to less than 5 years5 years or more Proficiency in French (Oral Interaction) NoneBasicModerateHigh Proficiency in English (Oral Interaction) NoneBasicModerateHigh Have you ever stayed in Quebec? Not applicableTo study for 1 regular full-time semesterTo study for 2 regular full-time semestersTo work for at least 3 monthsTo work for at least 6 monthss part of a youth exchange program contemplated by an international agreement made by Québec or an international agreement made by Canada, if work was the main activity for at least 3 monthsAs part of a youth exchange program contemplated by an international agreement made by Québec or an international agreement made by Canada, if work was the main activity for at least 6 monthsFor business for at least 1 weekOther stay for at least 2 weeksOther stay for at least 3 months Do you have a family in Quebec? Not applicableSpouse or de facto spouseSon or daughter, father or mother, brother or sisterGrandfather or grandmotherUncle or aunt, nephew or niece For Entrepreneur Class - Based on what are you able to carry out business in Quebec?? Not ApplicableMarket ExplorationFeasibility of ProjectMarket Exploration [cf7mls_step step-2 "Back" "Next"] Admissibility Details These questions relate to the applicant i.e., the person who will be immigrating to Canada. Had any serious disease or physical or psychological disorder? NoYes Been convicted of or are currently charged with a criminal offence in any country? NoYes Applied previously for a temporary visa to Canada? NoYes Applied previously for permanent residence in Canada? NoYes Been refused a visa to Canada or any other country? NoYes Been refused admission to or order removed from Canada or any other country? NoYes Been involved in the commission of human rights violations, acts of subversion, espionage, terrorism, or organized criminality? NoYes If you answered yes to any of the above questions, please provide details here. Financial Information (in Dollars) Total Monthly Income of you and your spouse Total Net Worth of Your Family Total Savings (in Banks and Other Investments) Brief description of financial resources to cover immigration costs Final Information How did you come to know about us? Online AdvertisementReferred By A ClientSearch Engine (Google) Provide any additional information here that you think may be important to access your eligibility. Or paste your text resume: 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 your firm can use this information to contact me via all modes of communication and send information as required.
