Form | Atlantic Fusion

Assessment Form

First Name (required) Last Name (required) Date of Birth Gender: FemaleMale Country of Citizenship Country of Residence Current Residential Address Mailing Address Telephone Home Telephone Work Email Address (required) Marital Status Do you have any dependent children? YesNo Have you ever been to Canada? YesNo If you have lived in Canada, for how long? Do you have Family and/or Friends in Canada? YesNo Which province? Language & Education Your highest level of education: Have you ever had your education assessed for its Canadian equivalency? If so, what was the Canadian equivalent? Your spouse’s / common-law partner’s area(s) of training and/or study: Your area(s) of training and/or study: Language Skills Have you taken an English test (IELTS or CELPIP) in the past two years? YesNo What was the score in the four categories? Reading: Listening: Writing: Speaking: Employment What is your current occupation? What is your spouse / common-law partner’s current occupation? Please list the paid jobs you have held the last 10 years: Questions & Comments Please use this space to send any specific questions, comments or additional information that may be relevant to your inquiry.