First Canadian Immigration Services

• Why Canada • About Us • Why F.C.I.S • Seminars

• Testimonials • Contact Us • How Do I Begin?

• Standard of Living Comparisons

• Truck Driving Comparisons

Part A: Personal Details

First Name:

Middle Name:

Last Name:

Other Name (e.g. Maiden):

Full Name in Native Language:

Birthdate (e.g. May 4, 1972):

Place of Birth:

Birth Country:

My Present Marital Status is:

Never Married	Married
Divorced	Separated
Widowed	Annulled Marriage
Common-Law

If applicable, number of times married:

I am a citizen of:

Current Country of Residence:

My Mailing Address is:

My Current Residential Address is:

My Telephone Number is:

My Faxsimile Number is:

My Email Address is:

My Passport Number is:

Country of issue:

Date of expire (dd/mm/yyyy):

My current occupation is:

My intended occupation in canada is:

Part B: Education

Level of Education:

No Secondary	Secondary
Trade/Apprenticeship	Bachelor's Degree
Non-university Certificate/Diploma	Masters Degree
Some University; No Degree	Ph. D.
Some Post-graduate Studies; No degree

I have completed a one to two year post-secondary (after school) programa: Yes No

Education History
Institution	Start Date (DD/MM/YYYY)	End Date (DD/MM/YYYY)	City and Country	Type of diploma received

I have an apprenticeship or trade certificate based on at least three years of combined study: Yes No

Education History
Institution	Start Date (DD/MM/YYYY)	End Date (DD/MM/YYYY)	City and Country	Type of diploma received

I have a university degree or diploma that required at least three years of fulltime post-secondary study: Yes No

Education History
Institution	Start Date (DD/MM/YYYY)	End Date (DD/MM/YYYY)	City and Country	Type of diploma received

I have a second or third level university degree, e. g. masters or doctor: Yes No

Education History
Institution	Start Date (DD/MM/YYYY)	End Date (DD/MM/YYYY)	City and Country	Type of diploma received

Are you willing to settle in a rural area outside of the City of Winnipeg?		Yes No

Or do you wish to reside in a city environment in Manitoba?		Yes No

Part C: Work Experience

Are you a recent graduate and have no work experience?		Yes No

Do you have one year or more of general experience completed within the last ten years?		Yes No

Do you have one ore more years related to a skilled occupation?		Yes No

If so, indicate the exact number of years related in a skilled occupation including the date you commenced the occupation, the name and address of the employer and if you are no longer with that employer, the date the employment ended. If you have more than one skilled occupation, answer these questions for each occupation.

Skilled occupation	Date employment commenced (DD/MM/YYYY)	Date employment ended (DD/MM/YYYY)	Employer's name and address	Number of Years

Part D: Language

English or French is my first language and I am fluent in English or French.		English French

Fluent in English or French, currently immersed: I am currently working and/or studying in either language and have been for at least the last 2 years.		English French

I have lived and worked or studied for a minimum of 3 years in an English or French speaking environment (must be within the last 5 years).		English French

I have had at least 2 years full time formal education at the secondary and/or post- secondary level, or worked for at least 2 years in an environment where English or French is the primary language (must be within the last 10 years).		English French

I am from a country in which English or French is a common second language and I was taught and used English or French in the school system.		English French

I have been interviewed in person or by telephone by my potential employer, who has verified that my English or French language abilities are adequate for the position I have been offered. The work requires English or French.		English French

I have studied some English or French in a recognized course but would still have trouble working in either language.		English French

I have a guaranteed offer of employment and have spoken with my employer. Although my English/French is very limited, the language I speak will allow me to perform all duties associated with the job I have been offered.		English French

I have very basic language skills and grammar. I have difficulty reading, writing and speaking in either language.		English French

I know a few simple expressions and can answer very basic questions in English or French.		English French

I know a few words of English or French.		English French

I have no knowledge of English or French.		English French

Part E: Assessment of Settlement Funds

Please advise as to the amount of funds that you would have available for coming into Canada due to becoming a successful applicant and entitled to become a permanent resident and move to Manitoba.

In Canadian Dollars:

Or in Euros:

Part F: Medical Information

Are you, your spouse and dependants all in good health (please check one):

Yes No

If no, indicate who is not in good health and briefly describe the medical condition below and how it is being treated:

Part G: Criminal Record

Do you, your spouse or any of your dependants have a criminal record?:

Yes No

If yes, please indicate below, who has a criminal record and the nature of the offence and the date of the conviction:

How Should We Contact You?:

By E-mail
By Telephone

Additional Notes:

Only fully completed applications will be considered and promptly answered.

*You will be receiving confirmation that this form has been sent . If you have any problems please email us directly as info@first-cis.com or call us at 001 204 895-2600.

• Why Canada • About Us • Why F.C.I.S • Seminars

• Testimonials • Contact Us • How Do I Begin?

• Standard of Living Comparisons

• Truck Driving Comparisons