Please be assured that all the information you give us will be kept STRICTLY CONFIDENTIAL by Siminca.
Only a few minutes are required to answer this questionnaire. Your answers are important: the more precise they are, the better we may tailor our advice to your needs.

IDENTITY
Family name Given name
Age Sex
M F
 Country of citizenship
Country of residence
City where you reside
Native language Current marital status
Email address
Age of your spouse/common-law partner
  IMPORTANT: Please ensure that this is a valid email address so you may receive our recommendations
Telephone number
Do you or your spouse/common-law partner have children?
Yes No
Number of children :
12 years old or less
13-21 years old
22 years of age and over
    
     

EDUCATION
IMPORTANT: Please specify the number of years of successful studies for each full time education level (Primary, secondary, etc.). If you have studied part-time, specify the number of full time years usually required to successfully complete this study program. Do not include diplomas which have been granted by private educational institutions which are not recognized by the government of the country where you have studied.
     
Diploma received
  
Number of years of successful study
Field of study/training.
Specify or choose by clicking on the Field menu
Level of
graduation
Name of Diploma received: Ex. "MA, BA, etc"
Year of
graduation
Country
Kindergarden & Primary education
 
 
Secondary school & college (non-university): general
 
Non-university professional or technical education            
First diploma
 
Second diploma
 
University education
            
First diploma
Second diploma
Third diploma
TOTAL
Ensure that this total corresponds to the number of years of study that you have completed successfully, without any duplication.

KNOWLEDGE OF ENGLISH AND FRENCH
Please choose the level which best describes your language ability.
 
Reading
Writing
Listening
Speaking
French
English

WORK EXPERIENCE
Describe your current occupation and occupations during the past 10 years.
   
Start
End
Weekly
  

   
hours of
  
 
Job title
Year
Month
Year
Month
work
Country
Brief description of your job
1
2
3
4
5
6

EDUCATION [spouse or common-law partner who will accompany you]
IMPORTANT: Please specify the number of years of successful studies for each full time education level (Primary, secondary, etc.). If you have studied part-time, specify the number of full time years usually required to successfully complete this study program. Do not include diplomas which have been granted by private educational institutions which are not recognized by the government of the country where you have studied.
     
Diploma received
  
Number of years of successful study
Field of study/training.
Specify or choose by clicking on the Field menu
Level of
graduation
Name of Diploma received: Ex. "MA, BA, etc"
Year of
graduation
Country
Kindergarden & Primary education
 
 
Secondary school & college (non-university): general
 
Non-university professional or technical education            
First diploma
 
Second diploma
 
University education
            
First diploma
Second diploma
Third diploma
TOTAL
Ensure that this total corresponds to the number of years of study that you have completed successfully, without any duplication.

KNOWLEDGE OF ENGLISH AND FRENCH [spouse or common-law partner who will accompany you]
Please choose the level which best describes your language ability.
 
Reading
Writing
Listening
Speaking
French
English

WORK EXPERIENCE [spouse or common-law partner who will accompany you]
Describe your current occupation and occupations during the past 10 years.
   
Start
End
Weekly
  

   
line
line
hours of
  
 
Job title
Year
Year
Année
Month
work
Country
Brief description of your job
1
2
3
4
5
6

BUSINESS EXPERIENCE AS OWNER, MANAGER OR SELF EMPLOYED-WORKER
Do you or your spouse or common law partner have experience as owner or in management of a business or as a self-employed worker?
Yes No
Have you owned or controlled a percentage of the equity of a business AND managed this business alone or with other persons ?
Yes (myself) Yes (my spouse/common-law partner)
No
Do you have management experience in:    

• an agricultural business or farm ?
Yes (myself) Yes (my spouse/common-law partner)
No

• a private industrial or commercial business ?
Yes (myself) Yes (my spouse/common-law partner)
No

• a business owned by a government or an international organization ?
Yes (myself) Yes (my spouse/common-law partner)
No
Do you have experience as a self-employed worker in a trade or profession ?
Yes (myself)
Specify which trade

Yes (my spouse/common-law partner)
Specify which trade

No


NET WORTH
I have a net worth in Canadian dollars (alone or in conjunction with my accompanying spouse/common-law partner) of:

Please enter a figure without any space, coma or decimal point. If you with to convert from your currency to Canadian dollars you may use the following
Currency Converter.


FAMILY OR VISITS/STAYS IN CANADA
Do you have family in Canada (spouse, commmon-law partner, father, mother, grandfather, grandmother, brother, sister) ?
Yes (myself)
Yes (my spouse/common-law partner)
Non
In Quebec In another Province
In Quebec In another Province
 
Have you visited Canada ?
Yes (myself)
Yes (my spouse/common-law partner)
Non
Le Québec In another Province
Le Québec In another Province
 
Have studied on a full-time basis in Canada ?
Yes (myself)
Yes (my spouse/common-law partner)
Non
In Quebec In another Province
In Quebec In another Province
 
Have you worked in Canada ?
Yes (myself)
Yes (my spouse/common-law partner)
Non
In Quebec In another Province
In Quebec In another Province
 

AMOUNT OF FUNDS WHICH YOU WILL BRING WITH YOU WHEN IMMIGRATING TO CANADA
When arriving in Canada as a permanent resident, what is the amount of available funds (IN CANADIAN DOLLARS) which you expect to have ?

Canadian dollar amount. PLEASE enter a figure without any spaces, coma or decimal point


PLEASE enter a figure without spaces, coma or decimal point. You may convert from your ceurrency to Canadian dollars by using the following
Currency Converter.


IMMIGRATION INFORMATION SEMINARS AND CONFERENCES
Do you wish to be invited to attend the immigration information seminar or conference which we will hold in your area ?

Yes No

RESUME
If you wish, you may send us you Resume by pasting it in the following box.


COMMENTS
If you wish, you may use the following space to send us any comment you may have or provide details about any of your answers to this questionnaire.


PLEASE TELL US HOW YOU HEARD ABOUT US?
Internet search Written advertisement (Newspaper, other) Internet advertisement Siminca client
Other
Please specify:

I declare that the information I have provided in this questionnaire is truthful and I understand that SIMINCA will send me its recommendations to the email address I have provided, free of charge and without any obligation on my part.


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