Preliminary Questionnaire

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



exactly as shown on your passport, including special characters


Mail address

street, street number, city, ZIP Code


Phone number

including international prefix




Place of birth

city and country


Date of birth


Marital status


Language ability




Number and age of children




if you have more than one citizenship, write down all



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.