Express Entry Free Assessment Form All information submitted is kept strictly confidential. View Privacy Policy A. PERSONAL DETAILSFull Name*GenderMaleFemaleDate of BirthPlace of BirthCitizenship*Country of Residence*Marital StatusNumber of childrenAge of ChildrenCONTACTSFull Postal AddressEmail Address*Phone Number*SPOUSE’S (HUSBAND, WIFE, OR COMMON-LAW PARTNER) PERSONAL DETAILS (IF APPLICABLE)Full NameGenderMaleFemaleDate of BirthPlace of BirthCitizenshipCountry of ResidenceB. EDUCATIONYour total number of years of full-time education:Highest level of education achieved:Please selectSecondary school1-year post-secondary credential2-year post-secondary credential3 or more year post-secondary credentialTwo or more post-secondary credentials, one of which was at least 3 years in durationBachelor DegreeUniversity credential at the master’s or professional levelUniversity credential at the doctoral levelDetails of education (provide type of degrees/diplomas, where obtained, full or part-time, area of study, and whether program was completed):SPOUSE’S EDUCATION (IF APPLICABLE)Highest level of education achievedPlease selectSecondary school1-year post-secondary credential2-year post-secondary credential3 or more year post-secondary credentialTwo or more post-secondary credentials, one of which was at least 3 years in durationBachelor DegreeUniversity credential at the master’s or professional levelUniversity credential at the doctoral levelDetails of education: (provide type of degrees/diplomas, where obtained, full or part-time, area of study, and whether program was completed)C. LANGUAGE SKILLSENGLISHSpeaknonebasicwellfluently Listen (oral comprehension)nonebasicwellfluently Readnonebasicwellfluently WritenonebasicwellfluentlyFRENCHSpeaknonebasicwellfluently Listen (oral comprehension)nonebasicwellfluently Readnonebasicwellfluently Writenonebasicwellfluently If you have ever been tested for language ability under the IELTS, CELPIC or the TEF test, please record your scores here.SPOUSE’S LANGUAGE SKILLS (IF APPLICABLE)ENGLISHSpeaknonebasicwellfluently Listen (oral comprehension)nonebasicwellfluently Readnonebasicwellfluently WritenonebasicwellfluentlyFRENCHSpeaknonebasicwellfluently Listen (oral comprehension)nonebasicwellfluently Readnonebasicwellfluently WritenonebasicwellfluentlyD. WORK EXPERIENCETotal number of years of full-time skilled work experience in the past 10 years:Present jobJob TitleCompanyCompany LocationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 1Job TitleCompanyCompany LocationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 2Job TitleCompanyCompany LocationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 3Job TitleCompanyCompany LocationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 4Job TitleCompanyCompany LocationPart-time/Full-timeFrom month/yearTo month/yearAre there any details you wish to add about your work experience?If you wish to attach your resume please paste it here.SPOUSE’S WORK EXPERIENCE (IF APPLICABLE)Total number of years of full-time skilled work experience in the past 10 years:Present jobJob TitleCompanyCompany LocationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 1Job TitleCompanyCompany locationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 2Job TitleCompanyCompany locationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 3Job TitleCompanyCompany locationPart-time/Full-timeFrom month/yearTo month/yearPrevious job 4Job TitleCompanyCompany locationPart-time/Full-timeFrom month/yearTo month/yearE. ARRANGED EMPLOYMENTAre you currently working in Canada with a work permit for which a Labour Market Opinion has been obtained, and is your employer willing to offer you a permanent position?YesNoDo you have a job offer from a Canadian company that is willing to employ you permanently once you obtain permanent residence?YesNo Is your spouse or partner (if applicable) currently working in Canada with a work permit for which a Labour Market Opinion has been obtained, and is their employer willing to offer them a permanent position?YesNoDoes your spouse or partner have a job offer from a Canadian company that is willing to employ them permanently once they obtain permanent residence?YesNoF. ADAPTABILITYHave you or your spouse or common-law partner studied full-time in Canada for at least a two-year period?YesNoHave you worked full-time in Canada in a skilled occupation for at least a one-year period?YesNoHas your spouse or common-law partner worked full-time in Canada for at least a one-year period?YesNo Do you or your spouse have any family members in Canada who are citizens or permanent resident?YesNoWhat is the nature of the family relationship?G. NET WORTHWhat is your monetary net worth, including your assets and the assets of your spouse, in Canadian dollars?I. ADMISSIBILITY Have you, your spouse, or any of your children:Had any serious disease or physical or psychological disorder?YesNoBeen convicted of or are currently charged with a criminal offence in any country?YesNoApplied previously for a temporary visa to Canada?YesNoApplied previously for permanent residence in Canada?YesNoBeen refused a visa to Canada or any other country?YesNoBeen refused admission to or order removed from Canada or any other country?YesNoBeen involved in the commission of human rights violations, acts of subversion, espionage, terrorism, or organized criminality?YesNo If you have replied “yes” to any of the above questions, please provide details:K. FINAL DETAILSIf there is anything else that you believe is important in relation to your qualifications please note it here.DECLARATIONI certify that the above information provided by me in the Free Assessment is true.*Yes, TrueI consent to the law office of Matthew Jeffery, Barrister & Solicitor, contacting me in relation to the above Free Assessment.*YesSendThis field should be left blank