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Free Online Evaluation Form
CVRS Inc.


     

Section A
(Applicant Information)
Personal Information
Name:
Email Address: (Required)
Sex: Male        Female
Date of Birth: Day:     Month:     Year:
Country of Birth:
Current Mailing Address & Current Country of Residence:
Phone Number:
Marital Status: Single
Married
Divorced/Separated
Widow
 
Languages
English Language
Speak:
Read:
Write:
Understand/Listen:
French Language
Speak:
Read:
Write:
Understand/Listen:
 
Education
 Period   Name, City, & Country of Institution Certificate Field of Study
From
(mm/yy)
To
(mm/yy)
If you selected "Other" in the Certificate field, please indicate in the space provided below the details and description of the certificate. In addition, you may type any other related educational experience that you have in the space provided below:

Total Years of Study (Including Primary/Elementary Schooling):
 
Employment
Company/Organization 1
Name of Company/Organization:
Company/Organization City:
Company/Organization Country:
Job Designation/Title:
Status: Full Time
Part Time
Employment Period:
From         Month:      Year:
To         Month:      Year:
Please check this box if you are still employed and working at this company    
Detailed Employment Responsibilities and Duties:
 
Company/Organization 2
Name of Company/Organization:
Company/Organization City:
Company/Organization Country:
Job Designation/Title:
Status: Full Time
Part Time
Employment Period:
From         Month:      Year:
To         Month:      Year:
Please check this box if you are still employed and working at this company    
Detailed Employment Responsibilities and Duties:
 
Company/Organization 3
Name of Company/Organization:
Company/Organization City:
Company/Organization Country:
Job Designation/Title:
Status: Full Time
Part Time
Employment Period:
From         Month:      Year:
To         Month:      Year:
Please check this box if you are still employed and working at this company    
Detailed Employment Responsibilities and Duties:
 
Please type in the field below any additional employment experience that you want to explain in detail:

 
Relatives in Canada if Any
 Relative Name   Relationship Province of Residence Status in Canada
 
Net Worth
Total value of your assets in US dollars (Personal Net Worth):
 
Offer of Employment
Do you currently have an offer of employment from a Canadian employer? Yes
No
If you answer "Yes" to the previous question, then please provide details here:
 
Section B
(Spouse Information if Married)
Personal Information
Date of Birth: Day:     Month:     Year:
 
Languages
English Language
Speak:
Read:
Write:
Understand/Listen:
French Language
Speak:
Read:
Write:
Understand/Listen:
 
Education
 Period   Name, City, & Country of Institution Certificate Field of Study
From
(mm/yy)
To
(mm/yy)
Total Years of Education Starting From The Primary School:      
Total Number of Years and Months of working experience:      
Please Provide Full Employment Details in the Field Provided Below if Any:
 
Section C
(Dependant Children if Any)
Details on Dependant Children
 Name   Relationship Date of Birth
(Day/Month/year)
 
Section D
(Additional Information)
Other
Have you, your spouse, or common-law partner ever:
Had a contagious or serious disease? Yes
No
Visited Canada to Study, work, or Visit? Yes
No
Applied before for an immigration visa to Canada? Yes
No
Commited, charged with, or convicted previously or currently with a crime or an offence? Yes
No
If you answer "Yes" to any of the above questions, then please provide details here:
 
Will you be able to obtain a visitor visa to Canada? Yes
No
 
Additional Comments if Any
 


     

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