Personal Information Form

Step 1 of 10

PERSONAL INFORMATION FORM

(All fields MUST be filled properly with complete details. Any field not applicable to you should be stated as NILL).

Full Name (exactly as it is in your International Passport): *

Date of Birth *

Place & Country of Birth *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Gender *

Present Occupation *

Native Language *

Language Proficiency *

Phone *

Email *

EDUCATIONAL INFORMATION ( PRIMARY SCHOOL )

Name of School *

School Address *

City , State and Country

Start Date *

End Date *

Certificate Received *

E.g. First School leaving certificate

EDUCATIONAL INFORMATION ( SECONDARY SCHOOL )

Name of School *

School Address *

City , State and Country

Start Date *

End Date *

Certificate Received *

E.g. Secondary School leaving certificate

EDUCATIONAL INFORMATION ( TERTIARY EDUCATION )

Program

School Address *

City , State and Country

Start Date *

End Date *

Course of study *

Graudation Grade *

EMPLOYMENT HISTORY INFORMATION (MUST be up to 10 years)

Name of Current or Last Employer / Company *

Current Activity / Occupation *

Location of Employment *

City , State and Country

Start Date *

End Date *

Previous Employer's details

Name of Previous Employer / Company

Past Activity / Occupation

Location of Employment

City , State and Country

Start Date *

End Date *

Previous Employer's details (Additional Sheet

Name of Previous Employer / Company

Past Activity / Occupation

Location of Employment

City , State and Country

Start Date *

End Date *

Emergency Information

Name *

First

Middle

Last

Phone Number

Email *

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Relationship *

BACKGROUND INFORMATION

BACKGROUND INFORMATION You must complete this section if you are 18 years of age or older.

Question 1. A Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?

Question 1. B Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?

If you answered "yes" to question 1a) or 1b), please provide details and the name of the family member (if applicable)

Question 2. A Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?

Question 2. B Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory?

Question 2. C Have you previously applied to enter or remain in Canada

If you answered “yes” to question 2a), 2b) or 2c), please provide details.

REFUSED BASE ON LIMITED ASSETS AND FINANCE ETC.

3 . A Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country or territor

3. B If you answered “yes” to question 3a) above, please provide details.

4 . A Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve

4. B If you answered yes to question 4a), please provide dates of service and countries or territories where you served.

5. Are you, or have you ever been a member or associated with any political party, or other group or organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time

6 . Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?