Canadian Immigration Assessment Form

1 - Personal Information
Name :ARUN C K Date of Birth :05/07/1988 Sex (Male/Female):MALE Mobile number:+91-9790778404 E Mail Id:ARUN6468@GMAIL.COM

2 - Family Composition
Present marital Status:SINGLE Number of Children with Age:

3 Education
Duration From To Academic & Professional Qualification
2003 2004 SSLC

Marks Obtained
59%

Name of School/University with country

EBENEZER HIGH SCHOOL VEETTOOR:GOVT OF KERALA

2004

2006

PLUS TWO

56%

FR.JOSEPH MEMORIAL HIGHER SECONDARY SCHOOL PUDUPPADY:GOVT OF KERALA

2006

2011

DIPLOMA IN NURSING

64%

NETHAJI INSTITUTE OF NURSING MANGALORE KARNATAKA NURSING BOARD

4 - Work History
Total number of years of experience with complete history of past 10 years: Duration From
2011

Name of the To Company

APOLLO HOSPITALS CHENNAI

Designation and Job Profile

STAFF NURSE

STILL WORKING

5 - Ability in Language ENGLISH:

SPEAKING: LISTENING: READING: WRITING:

6 - Ability in Language FRENCH:

SPEAKING: LISTENING: READING: WRITING:

Information on Spouse (Applicants Husband or Wife)

Name: Date of Birth : Sex (Male/Female):

7 Education
Duration From To Academic & Professional Qualification Marks Obtained Name of School/University with country

8- Ability in Language ENGLISH:

SPEAKING: LISTENING: READING: WRITING:

9 - Ability in Language FRENCH:

SPEAKING: LISTENING: READING: WRITING:

10 - Work History
Total number of years of experience with complete history of past 10 years: Duration From To Name of the Company Designation and Job Profile

11: Any self-employed profession by applicant or spouse during last 5 years?

Signature of Staff: Name of Office: