Questionnaire |
| Name, surname |
|
| Date of birth |
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| Place of Birth |
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| Citizenship |
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| Address |
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| Home Phone |
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| Work Phone |
|
| Mobile |
|
| E-mail |
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| Confirm E-mail |
|
Education after School |
Educational Institution -1
Full name of an educational institution
Date of receipt in institute.
Date of end of study.
Received degree and a specialty (for example, the Bachelor, engineers - mechanics) |
|
Educational Institution -2
Full name of an educational institution
Date of receipt in institute.
Date of end of study.
Received degree and a specialty (for example, the Bachelor, engineers - mechanics) |
|
Educational Institution -3
Full name of an educational institution
Date of receipt in institute.
Date of end of study.
Received degree and a specialty (for example, the Bachelor, engineers - mechanics) |
|
The Working Career after the ending of High School |
| Your labors activity for last 10 years. Specify only the experience received after reception of the diploma. Specify your posts and official duties, operation time on each place etc |
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Additional Information |
| Place here data on previous convictions, serious diseases to you or members of your family etc |
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| Level of knowledge of languages, which you can document about education, inquiries from a language course, certificates of tests etc |
| English |
| Speak |
fluent
well
with difficulty
not at all |
| Write |
fluent
well
with difficulty
not at all |
| Read |
fluent
well
with difficulty
not at all |
| French |
| Speak |
fluent
well
with difficulty
not at all |
| Write |
fluent
well
with difficulty
not at all |
| Read |
fluent
well
with difficulty
not at all |
| Purpose of filling of the given questionnaire |
Immigration to Canada
Work in Canada |
| I confirm, that all data specified by me in the given questionnaire, are absolutely true |
Yes
No |
| Date and place |
|
| Signature (if you send the given questionnaire by e-mail in this column specify your name and surname, that will be your electronic signature) |
|
|
| N.B. The tentative estimation of your opportunities borrows approximately 14 working days. After reception of confirmation from our Canadian partners, we shall contact you for the further registration and signing of the Contract about granting services |