Name *

First

Last

Email *

Phone

Place of Birth *

Country of Residence *

Country of Citizenship *

Date of Birth *

Marital Status *

Single
Married
Common-Law

If your Spouse Accompanying you?

Yes
No
Not applicable

Is your spouse a Canadian PR or Citizen?

Yes
No
Not applicable

Do you have children under the age of 22? *

How many family members do you have (including yourself)?

What is your preferred destination in Canada?

Please describe your proficiency in English and/or French under each of the four skills listed below.

Excellent: You have fluent command of the language, with full understanding and no difficulty with expression. Your use of terms is accurate and appropriate.

Good: You can express yourself and control complex language with detailed reasoning. Unfamiliar situations may result in slight errors or misunderstandings.

Limited: Understanding and expression is difficult, and limited to familiar situations. Language use is limited, and you are not able to use complex language.

English

Writing

Reading

Speaking

Listening

French

Writing

Reading

Speaking

Listening

Have you completed high school (Secondary Education)? *

Have you received any education or training other than high school (secondary school)? *

Please list all of your education and/or training other than high school (secondary school), starting with the most recent:

PHD
Masters
Bachelors
College or Non University
Professional or Vocational
Apprenticeship
Trade Certificate
Associates Degree
Other

Have you had done paid work during the last 10 years? *

If yes: please indicate your Current (or most recent) paid occupation *

If you had more than one paid occupation in the last 10 years, please provide here the list of your other occupations by order of importance: First occupation

Second occupation

Third occupation

Total length of your work experience *

Employment Type

What were your work hours

Location of your work experience

Have you already submitted an Express Entry profile to the Government of Canada within the past 12 months

Have you already received an Invitation to Apply for permanent residence from the Government of Canada through the Express Entry system?

Do you have a written job offer from a Canadian employer?

Is this Job Offer supported by a Labour Market Impact Assessment (LMIA)?

Yes
No
I don’t Know

Do you have any family members or relatives living in Canada and who is 18 years or older and a Canadian citizen or permanent resident? *

Please select all those which apply to your situation

parent
grandparent
child
grandchild
your or your spouse’s sibling (child of your or your spouse’s parent)
your or your spouse’s aunt or uncle (by blood or marriage)
your or your spouse’s niece or nephew (grandchild of your or your spouse’s parent)

Do you have a close friend living in the Province of Manitoba who is 18 years or older?

Spouses – Date of Birth

What is your Spouse/Common-Law Partner's highest level of education completed?

PHD
Masters
Bachelors
College or Non University
Professional or Vocational
Apprenticeship
Trade Certificate
Associates Degree
Other

What is your Spouse/Common-Law Partner's English proficiency?

What is your Spouse/Common-Law Partner's French proficiency?

Has your Spouse/Common-Law Partner worked OUTSIDE of CANADA within the last 10 years?

Has your Spouse/Common-Law Partner worked INSIDE of CANADA within the last 10 years?

Please add any additional comments or questions relevent to your assessment

Skilled Workers Assessment Form

English

French