Preliminary Immigration Questionnaire |
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| Type of service: What type of service are you interested in? | |
| Other Service: | |
| Name: (as it appears in passport) | |
| Maiden / Other Name: | |
| Birth Date | | / | | / | |
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| Age: | |
| Sex: | |
| Citizenship: | (Indicate all) |
| Mother Tongue: | |
| Legal Status In Canada: | |
| Marital Status: | |
| Number Of Children: | |
| Children's ages: | e.g. 1,3,5, 7 or N/A |
| Country of Current Residence: | |
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| E-mail | |
| Phone (Primary): | |
| Phone (Other): | |
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| Address 1 | |
| Address 2 | |
| City | |
| Province | |
| Postal Code/Zip | |
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| Address 1 | |
| Address 2 | |
| City | |
| Province/State: | |
| Country: | |
| Postal Code: | |
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| Number of years completed at elementary school level: | |
| Number of years completed at high school level: | |
| Number of years completed at post secondary level: | |
| Highest level of education completed: | |
| School | Name of school where highest level of education completed: |
| Location of School (Country): | |
| Specialization/Program of study: | |
| Year of Graduation | |
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| FULL TIME work experience (30 hours or more per week) in the past 5 years | (Work experience includes military service, on-the-job training or specialized internships recognized by a diploma.): |
| PART TIME work experience (less than 30 hours per week) in the past 5 years | (Work experience includes military service, on-the-job training or specialized internships recognized by a diploma) |
| Title of Employment Position #1: | |
| Number of hours worked per week | |
| Employment #1 Start | | / | |
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| Employment #1 End | | / | |
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| Title of Employment Position #2 | |
| Number of hours worked per week: | |
| Employment #2 Start | | / | |
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| Employment #2 End | | / | |
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| Other Employment (in the last 10 years): | |
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| Level of oral comprehension of French: | |
| Level of oral expression of French: | |
| Level of oral comprehension of English: | |
| Level of oral expression of English: | |
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| Do you have a spouse / common law partner? | |
| Name (as it appears in passport): | |
| Maiden name/other name: | |
| Birth Date : | | / | | / | |
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| Age: | |
| Sex: | |
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| Number of years completed at elementary school level: | |
| Number of years completed at high school level: | |
| Number of years completed at post secondary level: | |
| Highest level of education completed: | |
| School: | (Name of school where highest level of education completed) |
| Location of School (Country): | |
| Specialization/Program of study: | |
| Year of Graduation | |
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| FULL TIME work experience (30 hours or more per week) in the past 5 years | (Work experience includes military service, on-the-job training or specialized internships recognized by a diploma.): |
| PART TIME work experience (less than 30 hours per week) in the past 5 years | (Work experience includes military service, on-the-job training or specialized internships recognized by a diploma) |
| Title of Employment Position #1: | |
| Number of hours worked per week: | |
| Employment #1 Start | | / | |
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| Employment #1 End | | / | |
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| Title of Employment Position #2: | |
| Number of hours worked per week: | |
| Employment #2 Start | | / | | / | |
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| Employment #2 End | | / | | / | |
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| Other Employment | |
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| Level of oral comprehension of French: | |
| Level of oral expression of French: | |
| Level of oral comprehension of English: | |
| Level of oral expression of English: | |
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Have you or your spouse stayed in Québec during the last 10 years?
(You may check off more than one.) | |
| Do you or your spouse have a relative in Québec who is a Canadian citizen or permanent resident? (You may check off more than one) | |
| Other Family | |
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| Have you or your spouse received a job offer from an employer in Montreal? | |
| Have you or your spouse received a job offer from an employer in Quebec but outside of Montreal? | |
| What is the name of the employer and the position offered? | |
| If yes, where is the job located? | |
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