PRIVATE & CONFIDENTIAL
ASSESSMENT QUESTION
FOR PERMANENT RESIDENCE IN
CANADA IRE
SANRO INTERNATIONAL
F-2,Srijees,
6,2nd Main Road,
Shenoy Nagar West,
Chennai – 600030
Ph : 044 26289669, 044 42015767
Email id : sanroint@yahoo.com
1
MY SURNAME(LAST NAME) IS:                          MY FIRST NAME IS :                             MY OTHER NAMES ARE :
2
SEX
MALE
FEMALE
3
Date of Brith
DAY
MONTH
YEAR
CITY OR TOWN
COUNTRY
4 I AM A CITIZEN OF:
5
MY CURRENT MAILING ADDRESS IS :
  E-MAIL:


TEL NO:
6
MY PRESENT MARITAL STATUS IS:
NEVER MARRIED
MARRIED
SEPARATED
DIVORCED
  WIDOW(ER)
7
ABILITY IN ENGLISH
ABILITY IN FRENCH
SPEAK
FLUENTLY
WELL
WITH DIFFICULTY
NOT AT ALL
FLUENTLY
WELL
WITH DIFFICULTY
NOT AT ALL
READ
FLUENTLY
WELL
WITH DIFFICULTY
NOT AT ALL
FLUENTLY
WELL
WITH DIFFICULTY
NOT AT ALL
WRITE
FLUENTLY
WELL
WITH DIFFICULTY
NOT AT ALL
FLUENTLY
WELL
WITH DIFFICULTY
NOT AT ALL
8
DETAILS OF MY POST SECONDARY EDUCATION

DATES
NAME OF INSTITUTION
(INCLUDING APPRENTICESHIP TRAINING)
CITY & COUNTRY
TYPE OF DIPLOMA OR
CERTIFICATE ISSUED
FROM
TO


9
MY PRESENT OCCUPATION IS :

GROSS MONTHLY EARNINGS:

10 MY INTENDED OCCUPATION IN CANADA :
11 MY WORK HISTORY FOR THE PAST 10 YEARS

DATES
NAME OF EMPLOYER
CITY & COUNTRY
MY OCCUPATION
FROM
TO

12
NAMES OF RELATIVES IN CANADA WHO ARE
PERMANENT RESIDENTS OR CITIZEN


13.ADDRESS OF PERSON NAMED IN 12:

RELATIONSHIP TO ME OF PERSON NAMED IN 12:

14. DESTINATION IN CANADA :
NAME OF CITY/TOWN: PROVINCE :
15 I HAVE THE FOLLOWING ASSETS (SHOW NET AMOUNT OR VALUE)

TRANSFERABLE     MONEY :

PROPERTY :

OTHERS :
SPOUSE'S QUALIFICATION :
PLEASE SPECIFY IF PART-TIME OR FULL-TIME DEGREE/DIPLOMA:

16 Detailed description of the job responsibilities on a day-to-day basis (200 words)

I declare that information given in this application is truthful,complete and correct.



Date :                                                                                                                                     SIGNATURE OF THE APPLICANT
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