Appointment Form First Name Last Name Address City Mobile Number Email Personal Profile Age Country of Residence Country of Residence United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Austna Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam British Indian Ocean Territory Bruner Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt Saivador Equatorial Guinea Equatorial Guinea Entrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary celand ndia Indonesia ran Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kozovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Libena Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Marinique Mauritania Mauntius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Niue Noriolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcair Poland Portugal Puerto Rico Qatar Romania Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sit Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Switzerland Syria Taiwan Tajikistan lanzania Thailand The Netherlands limor-Leste Togo Tokelau longa Trinidad and Tobago โบกเรเอ Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Ukraine United Arab Emirates: United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Aland Islands Country of Citizenship Country of Residence United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Austna Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam British Indian Ocean Territory Bruner Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt Saivador Equatorial Guinea Equatorial Guinea Entrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary celand ndia Indonesia ran Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kozovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Libena Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Marinique Mauritania Mauntius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Niue Noriolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcair Poland Portugal Puerto Rico Qatar Romania Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sit Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Switzerland Syria Taiwan Tajikistan lanzania Thailand The Netherlands limor-Leste Togo Tokelau longa Trinidad and Tobago โบกเรเอ Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Ukraine United Arab Emirates: United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Aland Islands Marital Status Single Married Divorced Widowed Separated Engaged Common-Law Partner Do you have any children under the age of 22? YES NO How many children do you have under the age of 13? None 1 2 3 4 or More How many children do you have aged 13 to 21? None 1 2 3 4 or More Blood Group B AB A A- A+ O+ B+ O- O Occupation Student Unemployed Employed Retired Doctor Preferred Destination in Canada No preference I am not sure Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories: Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Your Language Skills Please describe your proficiency in English and/or French under each of the four skills listed below Writing 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Reading 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Listening 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Speaking 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Overall Score 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Spouse Detail Age Select your Age Uder 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 or over Education Matric FSc Bachelors Master Work Experience Position Company How many years of experience Time Period Of Work From To Spouse Description Spouse Occupation Student Unemployed Employed Retired Doctor Degree in Subjects Bachelor of Architecture Bachelor of Arts Bachelor of Science Bachelor of Business Administration Bachelor of Computer Science Bachelor of Engineering Bachelor of Economics Bachelor of Education Bachelor of Laws Bachelor of Commerce MBA Law Bachelor of Technology Bachelor of Commerce Bachelor of Management Bachelor of Applied Science Master's Degree Engineering Education Master of Accountancy. Master of Advanced Study. Master of Agricultural Economics. Master of Applied Finance. Master of Applied Science. Master of Architecture. Master of Arts. Master of Arts in Liberal Studies. Master of Arts in Special Education. Master of Arts in Teaching. Master of Bioethics. Spouse Description Writing 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Reading 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Speaking 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Listening 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Overall Score 9 8.5 8 7.5 7 6.5 6 5.5 5 4.5 4 3.5 3 2.5 Your Education and Training Have you completed high school (secondary school)? YES NO Have you received any education or training other than high school (secondary school) YES NO Please list all of your education and/or training other than high school (secondary school), starting with the most recent: Type of Program Select type of Degree PhD Master's Bachelor's College or Non-University Professional or Vocational Apprenticeship Trade Certificate Associates Degree Other Program Duration Select Degree duration Less than 3 months 3 months and less than 6 months 6 months and less than 12 months 1 Academic year 2 Academic years 3 Academic years 4 Academic years or more Did you complete this program? YES NO If Any Add Another Program or Education Training (If Any) Select type of Degree PhD Master's Bachelor's College or Non-University Professional or Vocational Apprenticeship Trade Certificate Associates Degree Other Program Duration (Optional) Select Degree duration Less than 3 months 3 months and less than 6 months 6 months and less than 12 months 1 Academic year 2 Academic years 3 Academic years 4 Academic years or more Did you complete this program? (Optional) YES NO Degree in Subjects YES NO Your Work History Have you done any paid work during the last 10 years?* YES NO Starting with your current (or most recent) job, please list all the paid work you have done during the last 10 years: Occupation Select Expert Very good Good Competent Modest Limited None at all Length of Work Select Expert Very good Good Competent Modest Limited None at all When Select Expert Very good Good Competent Modest Limited None at all Work hours Full Time (At least 30 hours per week) Part Time (At least 15 hours per week) Less than 15 hours per week Type of Job On the payroll of any organization (i.e. commercial, governmental or other) Self-Employed or working for your own company or business Location Inside Canada Outside Canada Add Another Job (If Any) Occupation Select Expert Very good Good Competent Modest Limited None at all Length of Work Select Expert Very good Good Competent Modest Limited None at all When Select Expert Very good Good Competent Modest Limited None at all Work hours Full Time (At least 30 hours per week) Part Time (At least 15 hours per week) Less than 15 hours per week Type of Job On the payroll of any organization (i.e. commercial, governmental or other) Self-Employed or working for your own company or business Location Inside Canada Outside Canada Family Blood Relationship Father Mother Brother Sister Do you have a close friend living in the province of Manitoba who is 18 years or older? YES NO Do you have any family members or relatives living in Canada and who are 18 years or older? YES NO Your Personal Net Worth This question is optional. Net worth is considered for some immigration programs. Currency Pakistan Rupee (Rs.) Afghanistan Afghani ($) Albania Lek (Lek) Algeria Dinar (DA) Angola Kwanza (Kz) Argentina Peso ($) Armenia Dram (nn.) Aruba Guilder () Australia Dollar ($) Azerbaijan Manat (ман.) Bahamas Dollar ($) Bahrain Dinar (BD) Bangladesh Taka (t) Barbados Dollar ($) Belarus Ruble (p.) Belize Dollar (BZ$) Bermuda Dollar ($) Bhutan Ngultrum (Nu.) Bolivia Bolíviano ($b) Bosnia and Herzegovina Convertible Marka (KM) Botswana Pula (P) Brazil Real (R$) Brunei Darussalam Dollar (B$) Bulgaria Lev (лв.) Burundi Franc (FBu) Cambodia Riel () Canada Dollar ($) Cape Verde Escudo (CV$) Cayman Islands Dollar (CI$) Central African CFA Franc BEAC (FCFA) Chile Peso ($) China Yuan Renminbi (CN·) Colombia Peso ($) Communauté Financière Africaine (BCEAO) Franc (F) Comorian Franc (CF) Comptoirs Français du Pacifique (CFP) Franc (F) Congo/Kinshasa Franc (FC) Costa Rica Colon (X) Croatia Kuna (kn) Cuba Peso ($MN) Czech Republic Koruna (Kẽ) Denmark Krone (kr.) Djibouti Franc (Fdj) Dominican Republic Peso (RD$) East Caribbean Dollar ($) Egypt Pound (E£) El Salvador Colon (X) Eritrea Nakfa (Nfk) Ethiopia Birr (Br) Euro Member Countries (€) Falkland Islands (Malvinas) Pound (FKE) Fiji Dollar (FJ$) Gambia Dalasi (D) Georgia Lari (GEL) Ghana Cedi (C) Gibraltar Pound (E) Guatemala Quetzal (Q) Guernsey Pound (E) Guinea Franc (FG) Guyana Dollar (GYS) Haiti Gourde (G) Honduras Lempira (L) Hong Kong Dollar (HKS) Hungary Forint (Ft) Iceland Krona (kr) India Rupee (GPI) Indonesia Rupiah (Rp) Iran Rial (RI.) Iraq Dinar (ID) Isle of Man Pound (ME) Israel Shekel ( Jamaica Dollar ($) Japan Yen (7) Jersey Pound (£) Jordan Dinar (JD) Kazakhstan Tenge (тнг.) Kenya Shilling (KSh) Korea (North) Won (W) Korea (South) Won (W) Kuwait Dinar (K.D.) Kyrgyzstan Som (K.S.) Laos Kip () Lebanon Pound (LE) Lesotho Loti (L) Liberia Dollar (L$) Libya Dinar (LD) Macau Pataca (MOP$) Macedonia Denar (ден) Madagascar Ariary (Ar) Madagascar Ariary (Ar) Malawi Kwacha (MK) Malaysia Ringgit (RM) Maldives (Maldive Islands) Rufiyaa (Rf) Mauritania Ouguiya (UM) Mauritius Rupee (Rs) Mexico Peso (Mex$) Moldova Leu (MDL) Mongolia Tughrik () Morocco Dirham (Dh) Mozambique Metical (MT) Myanmar (Burma) Kyat (K) Namibia Dollar (N$) Nepal Rupee (Rps) Netherlands Antilles Guilder (NAf) New Zealand Dollar ($) Nicaragua Cordoba (CS) Nigeria Naira (A) Norway Krone (кг) Oman Rial (RO) Panama Balboa (B/.) Panua Now Guinca Kina (K Papua New Guinea Kina (K) Paraguay Guarani (G) Peru Sol (S/.) Philippines Peso (P) Poland Zloty (zt) Qatar Riyal (QR) Romania Leu (RON) Russia Ruble (py.) Rwanda Franc (FRw) Saint Helena Pound (E) Samoa Tala (WS$) Saudi Arabia Riyal (SR) Seborga Luigino (-) Serbia Dinar (d./д.) Seychelles Rupee (SR) Sierra Leone Leone (Le) Singapore Dollar (S$) Solomon Islands Dollar (SIS) Somalia Shilling (Sh. So.) South Africa Rand (R) Sri Lanka Rupee (Rs) Sudan Pound (SDG) Suriname Dollar ($) Swaziland Lilangeni (L) Sweden Krona (kr) Switzerland Franc (SFr.) Syria Pound (ES) São Tomé and Príncipe Dobra (Db) Taiwan New Dollar (NTS) Tajikistan Somoni (-) Tanzania Shilling (TSh) Thailand Baht (B) Tonga Pa'anga (TS) Trinidad and Tobago Dollar (TTS) Tunisia Dinar (DT) Turkey Lira (t) Turkmenistan Manat (T) Tuvalu Dollar (TV$) Uganda Shilling (USh) Ukraine Hryvnia (₴) United Arab Emirates Dirham (DH) United Kingdom Pound (£) United States Dollar ($) Uruquav Peso (SU) United Kingdom Pound (£) United States Dollar ($) Uruguay Peso ($U) Uzbekistan Som (U.S.) Vanuatu Vatu (VT) Venezuela Bolívar (Bs.) Viet Nam Dong (*) Yemen Rial (Ri) Zambia Kwacha (K) Zimbabwe Dollar (ZMS) Pakistan Rupee (Rs.) Amount Select less than 10,000 between 10,000 and 25,000 between 25,000 and 100,000 between 100,000 and 500,000 between 500,000 and 1,000,000 between 1,000,000 and 2,000,000 more than 2,000,000 Yes, please send me the free Canadian Immigration Newsletter by email. 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