1. First Name: Family Name: Mr./Ms. -- Mr. Ms. 2. Mailing Address: 3. Telephone: Home: Business: Fax: E-mail: 4. Date of Birth: (Day) (Month) (Year) 5. Marital Status: Single Married Divorced Widowed 6. Age of children, if any: 7. Have you, your spouse or your children ever had any serious medical problems? -- Yes No 8. Do you or your spouse have a criminal record? -- Yes No 9. Do you have close relatives in Canada? If yes, indicate the relationship: Brothers Sisters Parents Uncles Aunts Grandparents Nephews Nieces Other: 10.  EDUCATIONAL BACKGROUND: Secondary Education: Did you complete your secondary education? -- Yes No Did you obtain a trade certificate? If yes, what profession: Post-secondary Education: College or university (Name of institution): Faculty: Number of years:  -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Degree:  11. Present occupation: 12.  WORK EXPERIENCE: From YEAR To YEAR ENTERPRISE MAIN DUTIES 13.  LANGUAGE ABILITY - Please mark the appropriate column: ENGLISH FRENCH FLUENTLY WELL WITH DIFFICULTY FLUENTLY WELL WITH DIFFICULTY SPEAK: READ: WRITE: 14.  INFORMATION ABOUT YOUR SPOUSE: First Name: Family Name: Date of Birth: (Day) (Month) (Year) Secondary Education: Did you complete your secondary education? -- Yes No Did you obtain a trade certificate? If yes, what profession: Post-secondary Education: College or university (Name of institution): Faculty: Number of years: -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Degree: Present occupation: WORKING EXPERIENCE: From YEAR To YEAR ENTERPRISE MAIN DUTIES YOUR SPOUSE'S LANGUAGE ABILITY - Please mark the appropriate column: ENGLISH FRENCH FLUENTLY WELL WITH DIFFICULTY FLUENTLY WELL WITH DIFFICULTY SPEAK: READ: WRITE: 15. TRANSFERABLE ASSETS:(valuation in US$) Cash: Property: FOR BUSINESS APPLICANTS ONLY: 1. Please indicate the TYPE or nature of businesses in which you have been involved: 2. Specify your responsibilities and duties in the firm:  3.   Specify your percentage of ownership, if any:  4.   Number of employees in your present business:  5.   Turnover and net profit over the last 3 years: Year Turnover Net Profit 6. Net worth (in Canadian dollars) - all assets listed must be your personal holdings, and should be documented: The value of all your assets:   Funds available to be transferred to Canada: