A. GENERAL INFORMATION

Full name:*

Your sex:*

Male Female

Date of birth:*

Country:*

Marital status:*

Single Married/common-law relationship Divorced/separated Wideowed

Number of children under 12 years old:

Number of dependant children between 12 and 22 years old:

Number of dependant children 22 years old or older:

B. CONTACT INFORMATION

E-mail:*

Telephone number:*

Mobile number:

Address:*

C. EDUCATION

Total number of years (including primary education):*

Highest level of education:*

Secondary Post-secondary, a total of 12 years Post-secondary, a total of 13 years Post-secondary, a total of 14 years Post-secondary, a total of 15 years Bachelor degree Master degree PhD

Field of education:*

Graduation date:

Other degrees:

D. LANGUAGE ABILITIES

French:*

Oral comprehension french:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

Oral expression french:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

English:*

Oral comprehension:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

Oral expression:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

E. WORK EXPERIENCE

Number of years of full-time employment within the last 5 years:*

Present / Most Recent Employment Position:*

Starting date:*

Ending date:

Country, City:*

Type:*

Part time Full time

Other previous positions heldwithin the last 10 years:

Arranged employment in Canada?

Yes No

F. SPOUSE’S CHARACTERISTICS (If you are married or in a common-law relationship)

Relationship:*

Spouse Common-law partner Not applicable (Go to part G)

Accompanying you? *

Yes No

Full Name:*

Sex:*

Male Female

Date of birth:*

Total number of years of full-time education: (including primary school)::*

Highest level of education:*

Secondary Post-secondary, a total of 12 years Post-secondary, a total of 13 years Post-secondary, a total of 14 years Post-secondary, a total of 15 years Bachelor degree Master degree PhD PhD

Field of education:*

French:*

Oral comprehension french:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

Oral expression french:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

English:*

Oral comprehension english:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

Oral expression english:*

0 = none 1 2 3 4 5 6 7 8 9 10 11 12 = advanced

Number of years of full time work experience (within the last 5 years):*

Arranged employment in Canada? :*

Yes No

G. OTHER DETAILS

Have you or your spouse or de facto spouse stayed in Québec during the last 10 years? *

Student for 1 regular session, full-time Student during 2 regular sessions, full-time Worker for at least 3 months Worker for at least 6 months Stay for business for at least 1 week during the last 2 years (principal applicant only) Other stay for 2 weeks to 3 months Other stay for more than 3 months No stay

Have you or your spouse or common-law partner ever:*

Had any serious disease Been convicted of or currently charged with any crime or offence in any country Apply previously for an immigrant visa to Canada None

Relative residing in Canada (yours or your spouse’s, if applicable)(hold CTRL to select multiple):

Father/Mother Sister/Brother Son/Daughter Aunt/Uncle Niece/Nephew Grand-parent Other relative (blood-related) None

Relative’s status in Canada:

Relative’s place of residence:

Other important details you would like to add (ex. CV):