agence Ometz
FRANÇAIS

Ometz is a Jewish response to employment,
immigration, school & social services in Montreal

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Preliminary Immigration Questionnaire
Preliminary Immigration Questionnaire
A. PRINCIPAL APPLICANT: PROFILE
Type of service:
What type of service are you interested in?
Visitor Visa  Work Permit  
Student Permit  Permanent Residency 
Sponsorship Citizenship 
Other: 
Name: (as it appears in passport)
Maiden / Other Name:
Birth Date
/ /
Age:
Sex:
Male Female 
Citizenship:
(Indicate all)
Mother Tongue:
Legal Status In Canada:
Citizen Permanent Resident 
Temporary Worker Visitor  
Refugee Not in Canada 
Marital Status:
Single Married 
Common Law Union Separated 
Divorced Widow/Widower 
Number Of Children:
Children's ages:
e.g. 1,3,5, 7 or N/A
Country of Current Residence:
Contact Information
E-mail
Phone (Primary):
Phone (Other):
Address In Canada
Address 1
Address 2
City
Province
Postal Code/Zip
Foreign Address (If Applicable)
Address 1
Address 2
City
Province/State:
Country:
Postal Code:
B. PRINCIPAL APPLICANT: EDUCATION
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
C. PRINCIPAL APPLICANT: WORK EXPERIENCE
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
/
Employment #1 End
/
Title of Employment Position #2
Number of hours worked per week:
Employment #2 Start
/
Employment #2 End
/
Other Employment (in the last 10 years):
D. PRINCIPAL APPLICANT: LANGUAGE PROFICIENCY
Level of oral comprehension of French:
Level of oral expression of French:
Level of oral comprehension of English:
Level of oral expression of English:
E. SPOUSE: PROFILE
Do you have a spouse / common law partner?
Yes No 
I. PRINCIPAL APPLICANT AND SPOUSE: FAMILY AND STAY IN QUEBEC
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)
  
  
  
  
 
J. PRINCIPAL APPLICANT AND SPOUSE: EMPLOYMENT OFFER MADE BY AN EMPLOYER IN QUÉBEC
Have you or your spouse received a job offer from an employer in Montreal?
Yes No 
Have you or your spouse received a job offer from an employer in Quebec but outside of Montreal?
Yes No 
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