IJW Immigration Solutions

Preliminary Assessment Form

Please complete this form in full. Do not write in coloured areas; write N/A if a question is not applicable to you
NOTE: It is important that you fill out this form completely and accurately as misrepresentation of your background will deem your application invalid.
Personal Information
Your First Name (given name) Your Middle Name(s) Your Last Name (surname)

Date of Birth (dd/mm/yy) Sex (Male/ Female) Country of Birth Country of Residence (if different from country of birth)

Passport Number Country of Issue Date of Issue (dd/mm/yy) Date of Expiry (dd/mm/yy)

Current Address (Street, City, Province/State, Postal Code, Country)

Cell Phone (including area code) Home Phone (including area code) Email Address

Marital Status (married, single, If you are married, what is the date If in a common-law relationship, from If married/ in a common-law relationship, is your
common-law, separated, divorced etc) you were married? (dd/mm/yy) what date did you live together? partner immigrating to Canada with you?

Spouse/ Partners Full Name Date of Birth (dd/mm/yy) Sex (Male/ Female) Country of Birth

Passport Number Country of Issue Date of Issue (dd/mm/yy) Date of Expiry (dd/mm/yy)

Do you have children? (Y/N) How many children do you have? What are their ages? What are their names?

Indicate whether you have: worked in/studied Have you ever had a work permit or If you lived in Canada before, what were the dates?
in/visited/never been to Canada study permit in Canada? (Y/N) (dd/mm/yy)

List the total amount of funds you have that are legal Do you or your partner have close family If you answered YES to the question to the left, please state
and transferrable (Do NOT include equity in real estate) members who are permanent residents or the relationship of the family member to you/your partner
citizens of Canada and live in Canada now? (Y/N) and the name of the city in Canada in which he/she resides
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English Language Test – Have you taken an IELTS or CELPIP English language test in the last 2 years? (Y/N) If yes, complete the below:
IELTS or CELPIP? Ability Category Results
Reading

Date of Test (dd/mm/yy) Writing

Speaking

General or Academic? Listening

French Language Test – Have you taken a TEF French language test in the last 2 years? (Y/N) If yes, complete the below:
TEF Ability Category Results
Compréhension de l’écrit

Date of Test (dd/mm/yy) Compréhension de l’orale

Expression écrite

Expression orale

Education – Please provide the following information for your high school and ALL schools attended thereafter, whether completed of not.
From: (mm/yy) To: (mm/yy) Name of School City/ Country Type of Certificate or Area of Study – if not specific, write
Diploma Issued “General”

Educational Credential Assessment – Please disclose all education that has been assessed. (WES) for example – high school, 2-year diploma, 3 year degree, masters, phd etc
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Employment History – Please provide your employment history for the past ten (10) years-beginning with current-and include part-time positions.
From: (mm/yy) To: (mm/yy) Job Title City/ Country Name of Company, Street Address of CANADIAN
Employer, School, etc Employers ONLY

Travel – Please list all international travel in the last ten (10) years.
City and Country Purpose of trip From: (mm/yy) To: (mm/yy) Visa Issued (Y/N)

Funds – Please disclose how much funds you intend to bring to Canada if your application is accepted (in Canadian Dollars)
Cash
Other

How much money should you bring?

Bring as much money as you can to make moving and finding a home in Canada easier. Note, however, that Canadian customs regulations require you to declare if you are
bringing more than CAN$10,000 into Canada. If you do not tell them, you may be fined, and your funds could be seized. These funds could be in the form of:
 Cash,
 Documents that show property or capital payable to you (such as stocks, bonds, debentures, treasury bills, etc.), or
 Documents that guarantee payment of a set amount of money, which are payable to you (such as bankers’ drafts, cheques, travellers’ cheques or money orders).
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Additional Questions
Read the following carefully and answer truthfully. Have you or your spouse/partner or No Yes (Provide a detailed explanation in the space below)
dependents ever:
Have you had your highest level of education assessed? (ECA) If Yes, please indicate
the approved decision, (e.g. 2-year diploma, 3-year degree)
Been convicted of, or currently subject to any criminal proceeding in any country?

Previously sought refugee status in Canada or applied for Canadian immigrant or permanent
resident visa OR any other type of visa (temporary resident or visitor)?
Been denied refugee status, OR any type of visa (e.g. immigrant, permanent resident, visitor,
temporary resident) in Canada or any other country?
Been refused admission to or ordered to leave Canada OR any other country?

Been involved in an act of genocide, a war crime, a crime against humanity, or desecration of
religious property?
Used, use or plan to use violence as an end to achieve political, social or religious objectives?

Been a member of a group that is or was involved with organized crime?

Had any serious diseases or physical or mental disorders?

Is there any other information that you feel is important to share as part of your preliminary assessment?

Please complete this form in full answering all questions. Enter N/A where a question is not applicable in your case. Enter Y for yes and N for no.

When the form is completed, attach to an email and send to ian.j.woodconsulting@outlook.com

Thank you