GENERAL INFORMATION

    REMARK:Fields marked with an asterisk must be filled. Keep in mind that the more information you submit, the better your chances are.
    By filling this form, you agree with the privacy agreement.
    A) PERSONAL INFORMATION OF THE PRINCIPAL APPLICANT:
    Miss Mr(*)
      
  1. First Name:
    2.       		 (*)     
  2. Name:
    		3.  (*)   
  3. app #:
    		4.
      
  4. Street number:
    		5.  (*)       
  5. Street:
    		6.  (*)   
  6. Other:
    		7.
      
  7. City:
    		8.  (*)     
  8. Province/State/Other:
    		9.  (*)   
  9. Home country:
    		10.
      
  10. Zip Code:
    		11.  (*)     
  11. Mailbox, other:
    		12.  (*)
  12. Email :
    		13. (*)  
  13. Nationality:
    		14. (*)

     Contry codeRegional codeNumberInternationalPoste
  14. Home Phone:
    15. (*)
  15. Work Phone
    16. :     		 
  16. Fax:
    		17.
     
  17. Applicant's birthdate:
    		18.  (*) (*) (*)
  18. Civic status:
    19. (*)    		 Single Married Divorced/Separated
  19. Comments: (500 car. max.)
    		20.   

     B) LANGUAGE LEVEL OF THE PRINCIPAL APPLICANT:
     French
  20. Reading: (*)
    		21. High   Moderate  Basic  Not at all  
  21. Writing: (*)
    		22. High   Moderate  Basic  Not at all  
  22. Speaking: (*)
    		23. High   Moderate  Basic  Not at all  
     
     English
  23. Reading: (*)
    		24. High   Moderate  Basic  Not at all  
  24. Writing: (*)
    		25. High   Moderate  Basic  Not at all  
  25. Speaking: (*)
    		26. High   Moderate  Basic  Not at all  

     C) EDUCATION OF THE PRINCIPAL APPLICANT: Only include those that you have completed.
  26. DIPLOMA :
  27. Diploma title:
  28. Total number of years in school, including first school::
  29. Study field:
  30. Principal language in high school, undergraduate and graduate studies:
  31. Diploma beginning date:
    		32.
  32. Diploma completion date:
    		33.
  33. Establishment's name:
  34. City:
  35. Country:
    		36.
     

    D) PROFESSIONAL EXPERIENCE OF THE PRINCIPAL APPLICANT:
  36. Employer :
  37. Employer's name:
  38. Position:
  39. Beginning date:
    		40.
  40. Completion date:
    		41.
  41. Employment Status:
    		42. Part time   Full time  
  42. Tasks description (plaease provide details):
  43. City:
    		44.
  44. Country:
    		45.

    E) VARIOUS:
  45. Relationship with a Canadian citizen or permanent resident:
    		46.  Parent    Uncle/Tant   Brother/Sister   
       Son/Daughter   Niece/Nephew (22 years old and above)    Grand-parents    Friend
  46. Home province of your parent/friend:
    		47.
  47. Do you posess a written job offer signed by a Canadian employer?
    		48.  Yes No
  48. If you have answered "YES", please provide details (employer,description,location, duration, salary):

    49. G) ANSWER THE FOLLOWING QUESTIONS (CHECK IF THE SITUATION APPLIES):
    Principal respondant
  49. Have you previously applied for a tourism visa in Canada?(*)
    		50.  Yes No
  50. Please let us know how you got informed of our company:   (*)
    51.  Details
    Search engine:   
    Newspapers and magazines:  
    Newsgroups:   
    Recommendation
    Friend:  
  51. Additional comments:
    		52.

    I agree that information enclosed in this form are correct and that fraudulent information would exclude me from the process.