1

PRELIMINARY ASSESSMENT FORM

Immigration and Citizenship Lawyers
Dery & Associates

Personal information
Relatives (permanent residents or Canadian citizens) of applicant or spouse residing in Canada
Date of application
(dd / mm / yy) 01.02.2015First and Last name 0797103141
Relationship Phone No. City
Date of birth
Family name Abdel-Hadi First name Hamzeh (mm / dd / yy)
02.05.1985

Fax No. Email hamzeh.abdelhadi@yahoo.com

Address Balqaa City Sult

Country Jordan Postal Code 00962
Country of
Jordan
Country of birth residenc Jordan Citizenship Jordainian
Dependent children of principal applicant, spouse or de facto spouse e
Sex M F Marital status Single Married De facto spouse Separated Divorced Widowed
Number
Family and First Date of birth
Spouse or de facto spouse (ifany) name
Ashour Rana (mm / dd / yy)
04.06.1989
Children from 0 to 12 years old
PLEASE SPECIFY YOUR TOTAL PERSONAL NET WORTH:1100 Currency : JOD
Children from 13 to 17 years old
PLEASE SPECIFY HOW MUCH MONEY YOU WILL HAVE UPON YOUR ARRIVAL IN
Children 18 years old and over
CANADA:20000 Currency : JOD

TQ002_ENG
 2

Education: excluding elementary school (start with your most recent diploma)
N.B. : PLEASE SPECIFY IF PRIVATE OR STATE EDUCATIONAL INSTITUTION
From To
Primary language of
Name of educational institution / Country Name of diploma Specialization

Private
Yyyy Mm Yyyy mm education

State
2003 9 2007 7 Applied Balqa University/Jordan Bsc Applied Microbiology English

2002 9 2003 6 Baqaa School/Jordan Tawjihi Scientific Arabic

Employment during the past 10 years, including your own business, military service and internship experience (start with most recent)
From To Paid? No. of hours
Name of enterprise / Country Job title worked per
Yyyy Mm Yyyy Mm Yes No week
2013 1 2015 2 Apm (Part Of Hikma Group)/Jordan Qc. Supervisor 40
2011 1 2012 12 Apm (Part Of Hikma Group)/Jordan Qc. Sr. Analyst 40
2009 4 2010 12 Apm (Part Of Hikma Group)/Jordan Qc. Analyst 40
2007 7 2009 1 Mid Pharma Qc. Analyst 48

Language skills
Stay in Quebec
Advanced Intermediate Beginner None
From To
Have you ever : Yyyy Mm Yyyy mm French (Understand spoken)
Visited Quebec ? French (Ability to speak) English (Understand spoken) English (Ability to speak)
Studied in Quebec ?
Worked in Quebec?

TQ002_ENG
 3

Education: excluding elementary school (start with your most recent diploma)
N.B. : PLEASE SPECIFY IF PRIVATE OR STATE EDUCATIONAL INSTITUTION
From To
Primary language of
Name of educational institution / Country Name of diploma Specialization

Private
Yyyy Mm Yyyy mm education

State
2007 9 2011 5 Hashemite University/Jordan B.Sc Biotechnology English

2006 8 2007 5 Al-Sefaa School/Jordan Tawjihi Scientific Arabic

Employment during the past 10 years, including military service and internship experience (start with most recent)
Language skills
StayFrom
in Quebec To Paid? No. of hours
Name of enterprise / Country Job title Intermediate
Advanced Beginner Noneper
worked
Have
Yyyy you Mm
ever : Yyyy Mm From To Yes No week
2014 7 2015 1 Heba Hospital
Yyyy Mm Yyyy mm French (Understand
Laboratoryspoken)
Technician 42
2012 Visited2012
10 Quebec ?10
Speciality Hospital French (Ability to speak) Laboratory
English Technician
(Understand spoken) English (Ability to speak) 42
2012 7Studied in Quebec
2012 10 ? Plasma Labs Laboratory Technician 42
Worked
in Quebec?

TQ002_ENG