Free Canadian Internet Consultation

Persons seeking a free, no cost assessment to immigrate to Canada with our law firm may submit the following Consultation Questionnaire for review and assessment with Attorney Herman Dhade. In order to do so, we request that you complete the following Immigration Consultation Questionnaire in full and send it to our office by clicking the button marked "Send Data" at the end of the form.

The information contained in the form should be about the person who is seeking a temporary visa, permanent residence, citizenship or any other immigration benefit. It is important that you complete the form in its entirety. If you are an employer seeking to sponsor one or more employees, a separate questionnaire should be completed for each employee. If you are a citizen or Landed Immigrant seeking to assist a relative to immigrate to Canada, the information contained in the form should be about your relative.

If you do not receive a response by email within a few business days, your email address provided may be incorrect or invalid.

Personal Information
Name:
Email Address: In order to receive a reply, kindly ensure that you have sufficient space in your e-mail account. In addition, for Hotmail and Yahoo users our reply may be filtered as "Junk Mail".
Nationality:
Current Place of Residence: (City,Country)
Daytime Telephone number preceded by the area code: (areacode , phone number) Home, Office, or Mobile
Date of Birth:	Day Month Year
Sex:	Male Female
Marital Status :	Single Married Divorced/Separated
If Married, please provide Spouse's Characteristics in the fields below
Spouse's Date of Birth:	Day Month Year
Spouse's Level of Education and duration:	(If other please specify)
Spouse's total years of education: (Starting from primary school)
Spouse's field of study:
Spouse's Number of Years and Months of Working Experience:
Language Ability in French:
Number of Dependants:

Ability in English and French
English
Read
Write
Speak
Listen

French
Read
Write
Speak
Listen

Educational Profile
Total Years of education: (Starting from primary school)
1. Certificate:	(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

2. Certificate:	(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

3. Certificate:	(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:

Employment History
1. Name of Company/Organization:
Job Title:
From: (Month, Year)	To Present
Employment Status:	Part Time Full Time
Employment Duties: (please provide details)
City:
Country:

2. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status:	Part Time Full Time
Employment Duties: (please provide details)
City:
Country:

3. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status:	Part Time Full Time
Employment Duties: (please provide details)
City:
Country:

Other
� Relationship to Closest Relative in Canada (Canadian Citizen or Landed Immigrant):
Parent Aunt/Uncle Brother or Sister Son/Daughter Niece/Nephew (22 years or older) Grand Parent
Relative Province of Residence :

� Personal Net worth ($):

� Do you currently have an offer of employment from a Canadian employer?	Yes	No
If your answer to the above question is "Yes" provide details here:

� Have you or your spouse or common-law partner ever:
Had any serious disease	Yes	No
Been convicted of or currently charged with any crime or offence in any country	Yes	No
Applied previously for an immigrant visa to Canada	Yes	No
Visited Canada (visit,study,work)	Yes	No
Are you able to obtain a visitors visa to Canada	Yes	No
If answer to any of above is "Yes" provide details here:

� PLEASE INFORM US HOW YOU WERE INTRODUCED TO THIS SITE:
	Search Engine (please specify name & keywords used for the search)
	Newspaper or Magazine (please specify)
	Newsgroup (please specify)
	General Recommendation

� Additional Comments if Any:

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