1. Which is your country of residence? Canada United States Australia Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kozovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Åland Islands 2. Select your preferred destination in Canada No preference I am not sure Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon 3. How old are you? Under 18 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 or over 4. Select your marital status Single Married 5. Do you have any children under 19 years of age ? Yes No 7. English - Writing Expert Very good Good Competent Modest Limited None at all 8. English - Reading Expert Very good Good Competent Modest Limited None at all 9. English - Speaking Very good Good Competent Modest Limited None at all 10. French - Writing Expert Very good Good Competent Modest Limited None at all 11. French - Reading Expert Very good Good Competent Modest Limited None at all 12. French - Speaking Very good Good Competent Modest Limited None at all 14. Have you completed high school (secondary school)? Yes No 15. Have you earned a degree/diploma/certificate other than high school (secondary school)? Yes No 16. Have you completed this program? Yes No 17. Select Type of Program PhD Masters Bachelors College or Non-University Professional or Vocational Apprenticeship Trade Certificate Associates Degree Other 18. Program Duration Less than 3 months 3 months and less than 6 months 6 months and less than 12 months 1 Academic year 2 Academic years 3 Academic years 4 Academic years or more 19. Location Inside Canada Outside Canada 20. Kindly list all of your degree/diploma/certificate and/or training other than high school starting with the most recent. 22. In the last 10 years, do you have any paid work experience? Yes No 23. Type your Job Title 24. Work Duration 3 months 6 months 9 months 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years or more 25. Job Type Employed(On the payroll of any organization) Self-Employed (working for your own company or business) 26. Location Inside Canada Outside Canada 28. Have you already submitted an Express Entry profile within the last 12 months Yes No 29. Have you already received an Invitation to Apply (ITA) from the Government of Canada through the Express Entry system? Yes No 30. Do you have a valid job offer from a Canadian employer? Yes No 31. Does this Job Offer supported by a Labour Market Impact Assessment (LMIA)? Yes No I don’t know 33. Does any of your close friend (18 years or older) live in the province of Manitoba? Yes No 34. Does any of your family members/relatives (18 years or older) live in Canada? Yes No 35. Select relationship Spouse or Common-Law Partner Mother or Father Daughter or Son Grandmother or Grandfather Granddaughter or Grandson Sister or Brother Niece or Nephew (child of sister/brother) Aunt or Uncle (child of aunt/uncle) Distant Relative None 36. Select Residency Status Citizen Permanent Resident Work Permit Study Permit Other None 37. Select Province/Territory I am not sure lberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon None 38. Since when this person is living in this area Less than 1 year More than 1 year, but less than 2 years 2 years or longer None 40. Full Name 41. Email 42. Mobile/Phone Number 43. Please upload your Resume/CV. If possible, in MS-Word / PDF / Txt format. 44. Would you like to provide any additional information related to your immigration assessment? Yes No 45. Additional Information: SEND
