Assessment – Charis Immigration Services CIS

First Name*

Last Name*

City*

State*

Zip*

Country*

Email*

Phone*

Date Of Birth*

Marital Status*

Nationality*

Listening*

Reading*

Writing*

Speaking*

French*

Reading*

Writing*

Speaking*

Total years of education*

Type of Certificate

If other, please specify

Program Start Date

Program End Date

Location

Institute Name

Type of Certificate

If other, please specify

Program Start Date

Program End Date

Location

Institute Name

Title Of Job*

Name of Employer/Company*

Term of Employment*

Start Date*

End Date*

City*

Country*

Hours Worked*

Job Duties*

Title Of Job

Name of Employer/Company

Term of Employment

Start Date

End Date

City

Country

Hours Worked

Job Duties

Date Of Birth

Field Of Study

Education

English

French

Current Job Title

Ever refused a visa/entry to any Country?*
YesNo

Visited Canada Before?*
YesNo

Ever applied for immigration to Canada?*
YesNo

Personal Net-Worth in CAD$*

If Yes, provide detail

Please Select One
Search EngineNewspaper or MagazineReferralNewsgroup

Please specify name/title