Preliminary Assessment Questionnaire

    If you are interested in immigrating to Canada , please FILL OUT this questionnaire and CONTACT US by E-MAIL at : info@desti.ca  

    Your Information

    Last Name 

    First Name 

    Address 

    Birth date  In the format (MM/DD/YYYY)

    Sex Male Female

    Phone/Fax 

    E-mail 

    Nationality 

    What is your marital status?Single Married Divorced

    Education

    • Primary school Number of years attended 

      From  to 


    • Secondary school Number of years attended 

      Name of Institute 

      From  to 


    • University / College Number of years attended 

      Name of Institute 

      Diploma / Certificate obtained 

      From  to 


    Work History

    Please fill in the time/period of the job(s), the job title(s), the responsibilities of the job(s), and if any training of the job(s) obtained
    Applicant


    Spouse

    Languages

    English Speak  Read  Write 

    French Speak  Read  Write 



    Relative in Canada

    Please state clearly the name, address and relationship








    *** Thank you ***