Assessment Form - Vision Thrust Immigration Consulting

CLIENT INTAKE/ASSESSMENT FORM

1. Service Required (please select the option and explain the circumstance)

Service Required

Details:

1.1 Language

Preferred language

English

French

Other

State if other

2. Names (as they appear on your passport)

First name

Middle name

Last name

Date of Birth *

Place of Birth*

City*

Country of Birth*

2.1 Previous name

Did you have a previous name

Yes

No

First name

Middle name

Last name

Reason for the name change:

2.2

Sex

Marital status

No. of dependants

No. of Application to submit

3. Passport Details

Passport No

Date of Issue

Expiry Date

Place of issue

Country of issue

4 Contact details

Residential Information

House No

Street Name

Town/City

State/Region

Country

Area/Postal Code

Telephone

4.1 Is your mailing address different from your residential address?

Is your mailing address different from your residential address?

Yes

No

House No

Street Name

Town/City

State/Region

Country

Area/Postal Code

5. Emergency Contact

First Name

Last Name

Relationship

Address

House No

Street Name

City

State/Region

Country

Area/Postal Code

Telephone

Email address

6. Employment Information

Presently Working

Yes

No

Employment Information

Present Occupation

Job title

Start date

End date

Years of work experience

Job description (Please state clearly the duties performed/responsibilities)

7. Previous Employment

Previous Employment

Yes

No

Previous Employment

Present Occupation

Job title

Start date

End date

Years of work experience

Job description (Please state clearly the duties performed/responsibilities)

8. Education (state academic and professional qualifications)

1

Institution attended Name, City Country

From mm/yr

To mm/yr

Qualification Obtained

2

Institution attended Name, City Country

From mm/yr

To mm/yr

Qualification Obtained

3

Institution attended Name, City Country

From mm/yr

To mm/yr

Qualification Obtained

Do you have your academic transcripts in your possession?*

Yes

No

9. Travel History

Have you ever travelled outside your country of origin?*

Yes

No

Select the country?

If yes, please provide details of previous travels and the purpose of the travel.

Have you ever been refused a visa to any country?*

Yes

No

Have you ever been refused a visa to any country?

Have you ever applied for, travelled to, or refused a Canadian visa?*

Yes

No

10. Do you have a valid English or French language

Do you have a valid English or French language test result or both?

If yes, please provide details below

Test taken

Date of test

Test Report Form Number#

Overall test score

Scores

Listening

Reading

Writing

Speaking

For both please provide details below

English

Test taken

Date of test

Test Report Form Number#

Overall test score

Scores

Listening

Reading

Writing

Speaking

French

Test taken

Date of test

Test Report Form Number#

Overall test score

Scores

Listening

Reading

Writing

Speaking

11. Funds

How much money is available and accessible to you for your living expenses in /migration to Canada?

Do you confirm that the above information is true and acurate and can be used in any application on your behalf to IRCC?

Date

Please fill out the form below.

CLIENT INTAKE/ASSESSMENT FORM

1. Service Required (please select the option and explain the circumstance)

1.1 Language

2. Names (as they appear on your passport)

2.1 Previous name

2.2

3. Passport Details

4 Contact details

4.1 Is your mailing address different from your residential address?

5. Emergency Contact

6. Employment Information

Employment Information

7. Previous Employment

Previous Employment

8. Education (state academic and professional qualifications)

1

2

3

9. Travel History

10. Do you have a valid English or French language

If yes, please provide details below

For both please provide details below

English

French

11. Funds

11. Additional Information

Technique

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