Preliminary Application Questionnaire By filling out this form, we will collect the information necessary to assess your suitability for emigration or work permit to Canada. It is important for each adult applicant to complete it for himself. By completing the form, you do not bind yourself and this rating is free of charge. Given name exactly as shown on your passport, including special characters Surname exactly as shown on your passport, including special characters Mail address street, street number, city, ZIP Code Phone number including international prefix E-mail Place of birth city and country Date of birth Marital status SelectNever MarriedMarriedCommon-lawDivorcedSeparatedWidoved Language ability English Selectfluentlywellwith difficultynot at all French Selectfluentlywellwith difficultynot at all Number and age of children / Citizenship if you have more than one citizenship, write down all Education successfully completed years of secondary school years of university/ College years of apprenticeship/ training Details of secondary and post secondary education / apprenticeship training From - to (month/year) Name, type of school, faculty, branch... Type of certificate/diploma issued Work history since 18th birthday From - to (month/year) Name of employer and country Occupation Canadian visa Have you or member of your family ever applied for Canadian visa. If yes, when and what kind of visas. Health status Do you or your dependents have any serious medical disabilities? Relative in Canada List your relatives in Canada: name, address, their status in Canada and relationship. Criminal record Do you or your dependents have a criminal record? If yes, please provide details. Add a resume/ CV Add another document For example: a diploma, a certificate, a cover letter etc. By submitting the form, I give to company Hagiel explicit consent to the processing and recording of my personal data in accordance with the applicable privacy policy. I provide the data on our own discretion voluntarily, and these may be processed by Hagiel within the meaning of Act no. 428/2002 Coll. on the protection of personal data. I give the consent for an indefinite period and according to § 20 par. 3 of the Act it may be revoked at any time in writing. Hagiel undertakes that the provided data will not be provided to third parties without the written consent of the applicant.
