Employees form

EVERY ITEM WITH AN * MUST BE FILLED OUT.

MaleFemale

Family name *

First name

Address *

Postal code

Place *

Country *

Nationality *

Telephone Number *

Mobile Number *

E-mail address *

Age

Marrial Status *
SingleMarriedDivorcedWidow(er)

ChildrenYesNo

Age of Children

Wanted occupation in West Canada *

Years experience in wanted occupation

Occupation Partner

When do you want to immigrate?
1-6 months6-12 months1-2 years2-3 yearsmore than 3 years

To which province do you want to immigrate?
AlbertaBritish ColumbiaSakatchewanYukonNWT

Amount of money to start with in Canada
Less than $15,000$15,001-$25,000$25,001-$35,000More than $35,000

THE NEXT QUESTIONS WILL INDICATE US WHAT LEVEL OF KNOWLEDGE YOU HAVE ABOUT WESTERN CANADA

Have you ever been in Canada?
YesNo

If you have been in Canada, where have you been?
Have not been in CanadaAlbertaBritish ColumbiaSakatchewanYukonNWTMore than one of the Western provincesOther province in Canada

How long have you been in Canada? Weeks/months/years?

THE FOLLOWING QUESTIONS WILL INDICATE YOUR LEVEL OF ENGLISH

Level of speaking
poormediumgoodexcellent

Level of listening
poormediumgoodexcellent

Level of writing
poormediumgoodexcellent

Level of reading
poormediumgoodexcellent

Do you have any questions or remarks?
none

Would you like to be invited to one of our next information sessions?
YesNo

If you wanted to be invited to one of our next information sessions, which location do you prefer?
Information Session by SkypeDoesn't matter

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