Free Assessment Form - Moses Canadian Immigration Consulting Services

Client Name:

First

Last

Date of Birth:

Phone Number:

Email:

How many years of work experience do you have?

Please provide details of the main duties of the work performed:

What category of immigration are you interested in?

Level of Education:

Years of Post-Secondary Education:

Less than high school (secondary school)
High school diploma (secondary school graduation)
1-year diploma from college, university, technical or trade school
2-year diploma from college, university, technical or trade school
Bachelor’s degree or 3-year diploma from college, university, technical or trade school
More than one degree, certificate or diploma
Professional degree in dentistry, medicine, law, optometry, pharmacy, veterinary medicine or chiropractic medicine

Are you proficient in English?

Yes
No

Are you proficient in French?

Yes
No

Have you taken any of the following language tests?

IELTS
TEF/TCF/TOEFL
CELPIP

If yes, when did you take the language test?

Please provide your language test results for each skill below:

First

Last

Test results

First

Last

Do you have any family members in Canada?

Yes
No

Are they Canadian Citizens or Permanent Residents?

Canadian Citizen
Permanent Resident

If yes, where in Canada do they live?

Do you have a Spouse or Common-Law Partner? (If yes, please complete the following questions about your spouse/partner)

Yes
No

Name of Spouse or Common-Law Partner:

First

Last

How many years of work experience does your spouse/partner have?

Please provide details of the main duties of the work they performed:

Level of Education of Spouse/Partner:

Is your spouse/partner proficient in English?

Yes
No

Is your spouse/partner proficient in French?

Yes
No

Has your spouse/partner taken any of the following language tests?

IELTS
TEF/TCF/TOEFL
CELPIP

If yes, when did they take the language test?

Please provide their language test results for each skill below:

First

Last

Test results

First

Last

test? Do Education

Does your spouse/partner have any family members in Canada?

Yes
No

Are they Canadian Citizens or Permanent Residents?

Canadian Citizen
Permanent Resident

If yes, where in Canada do they live?

Permission & Agreement:

I agree and give my permission

*I am submitting this information voluntarily and I agree that the personal information I am providing is to be used for assessment purposes by MCICS, and no other party shall have access to this information.