Visa Rex Immigration - Immigration Assessment Questionnaire

Please complete this form to help us assess your eligibility for immigration programs. All information will be kept confidential.

Personal Information First Name:
Last Name:
Date of Birth:
Country of Citizenship:
Current Country of Residence:
Email Address:
Phone Number:

Education & Work Experience Highest Level of Education Completed:
High School
Associate Degree
Bachelor's Degree
Master's Degree
Ph.D.
Field of Study:
Current Occupation:
Years of Full-Time Work Experience:
Less than 1 year
1-3 years
3-5 years
5+ years

Language Proficiency English Proficiency:
Reading:
Writing:
Speaking:
Listening:
French Proficiency (if applicable):
Reading:
Writing:
Speaking:
Listening:

Immigration History Have you previously applied for a visa to Canada or any other country?
Yes
No
If yes, provide details:

Do you have close family members currently residing in Canada?
Yes
No
If yes, please specify:

Financial Information (For Business Immigration Assessment) Do you currently own a business?
Yes
No
If yes, provide details (Name, Industry, Country):

Net Worth (total assets minus liabilities):
Less than $100,000
$100,000 - $500,000
More than $500,000

Declaration and Consent I declare that the information provided is true and complete.
I consent to the processing of my personal data for immigration assessment purposes.