Canadian Consultation Questionnaire (Individual)

Please be aware that this form is for Canadian immigration consultations only. Do not use this questionnaire for U.S. immigration. If you require assistance with a U.S. immigration matter, please complete Henry J. Chang's US Consultation Questionnaire (Individual).

> The information submitted in this SSL encrypted questionnaire will be kept confidential. Once you have submitted your completed form, you will have an opportunity to schedule your consultation online.

Please note that initial consultations last up to one hour and a flat fee of $945.00 CAD (plus applicable GST/HST) will apply. However, certain consultations (such as those involving inadmissibility or citizenship claims) require additional analysis and are instead billed on a hourly basis. In such cases, you will be informed in advance that your initial consultation will exceed $945.00 CAD (plus applicable GST/HST) and you will be given an opportunity to confirm whether you still wish to proceed.

Once you have scheduled your consultation, we will contact you in order to request your credit card information. The initial consultation fee (plus GST/HST, if applicable) must be paid before your consultation takes place.

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REFERRAL INFORMATION

Were you referred to Henry Chang? Yes No

If yes, who referred you?

CLIENT OBJECTIVE

Briefly describe what you would like us to do for you:

COMPANY INFORMATION (IF APPLICABLE)

If you will be requesting that the consultation fee and/or any subsequent fees be billed to a business entity, please provide the following information:

General Information

Full Name of Corporation/Company/Partnership/Proprietorship::

Corporation Number/Business Registration Number:

Canadian Address of Corporation/Company/Partnership/Proprietorship:

Street and Suite Number:

City:

Province:

Postal Code

Address of Corporation/Company/Partnership/Proprietorship outside Canada (If Applicable)

Street and Suite Number:

City:

Province or State:

Postal or Zip Code:

Country:

Foreign Business Telephone:

Foreign Business Fax:

PERSONAL INFORMATION (PRINCIPAL APPLICANT)

E-mail Address (It is essential that this address be correct):

E-mail Address (Enter your email again):

Family Name:

First Name:

Middle Name:

Other Names Used (If married woman, give maiden and surnames of any previous spouses):

Birthdate (Month/Date/Year):

City & Country of Birth:

Citizenships Held:


Sex (M/F): Male Female

Marital Status:
Single
Engaged
Married
Common-Law Partner (cohabiting in a conjugal relationship at least one year)
Conjugal Partner (conjugal relationship of at least one year but not cohabiting)
Widowed
Divorced

If married, date and place of marriage:

Have you ever applied for Canadian permanent residence? Yes No

If yes, provide details below:

Do you have a parent or grandparent who was born in or is a citizen of
Canada? Yes No

If yes, provide details below:

CONTACT INFORMATION (PRINCIPAL APPLICANT)

Canadian Address

Street and Suite Number:

City:

State:

Zip Code

Home Phone:

Business Phone:

Fax:

Permanent Address Outside Canada

Street and Suite Number:

City:

Province or State:

Postal or Zip Code:

Country:

Home Phone:

Business Phone:

Fax:

If you are not currently a resident of Canada, we will need to determine whether you are subject to Goods and Services Tax/Harmonized Sale Tax. Please confirm the date that you formally became a non-resident for tax purposes and describe in detail any ties that you (or any business in which you may own an interest) have continued to maintain in Canada since that date:

VISA AND PASSPORT INFORMATION (PRINCIPAL APPLICANT)

Passport

Issued by (Country):

Issue Date:

Expiry Date:

Passport Number:

Visas

Current Visa Held:

Date Admitted:

Visa Expiry Date:

Previous Visa Held:

Date Admitted:

Visa Expiry Date:

Canadian Social Insurance Number:

PROSPECTIVE EMPLOYMENT IN CANADA (PRINCIPAL APPLICANT)

If you have a job offer in Canada, give the name and address of prospective employer:

If you have a job offer in Canada, what is the title of the proposed job and what will be your main duties?

If you have a job offer in Canada, what is your proposed salary?

Give any additional information about yourself here which would would help you establish your qualifications (List professional licenses, awards, prizes, membership in professional organizations, etc.) or explain your answers to the above questions:

PROSPECTIVE STUDY IN CANADA (PRINCIPAL APPLICANT)

Have you been accepted to study at a primary school, secondary school, college, university or technical institution in Canada? Yes No

If yes, provide details of the institution below (name of institution, address of institution, course of study, duration of program, and latest date for registration):

ABILITY TO SUPPORT ONESELF

Please describe what financial means you have available to support yourself during your stay in Canada:

EDUCATION (PRINCIPAL APPLICANT)

List the name and address of all schools, colleges, or universities attended beginning with your high school education, the dates of attendance at the school, the field of study and the degree or certificate received.

If you are licensed in any profession, please list location and date of licensure. Please indicate if license currently valid.

Describe any special qualifications, skills, proficiency in use of tools, machines, equipment or technology:

LANGUAGE ABILITY (PRINCIPAL APPLICANT)

English Ability:
Listen HighModerateBasicNot at all	Speak HighModerateBasicNot at all	Read HighModerateBasicNot at all	Write HighModerateBasicNot at all

French Ability:
Listen HighModerateBasicNot at all	Speak HighModerateBasicNot at all	Read HighModerateBasicNot at all	Write HighModerateBasicNot at all

HIGH: You can communicate effectively in most social and work situations.
MODERATE: You can communicate comfortably in familiar social and work situations.
BASIC: You can communicate in predictable contexts and on familiar topics, but with some difficulty.
NOT AT ALL: You do not meet the above criteria for basic proficiency.

EXPERIENCE (PRINCIPAL APPLICANT)

Describe in full all jobs whether in Canada or overseas, beginning with your present job. Be sure to list the employer's name, address, type of business, your job title, a description of your work, your ending salary and the dates of your employment. If you have previously owned part or all of a business, please provide details.

ARRANGED EMPLOYMENT (PRINCIPAL APPLICANT)

Assuming that you are seeking permanent residence, please provide details of any Labour Market Opinion and/or Canadian work permit that you may have recenty obtained for a skilled position in Canada(NOC Skill Level 0, A, or B):

ADAPTABILITY (PRINCIPAL APPLICANT)

If you have a spouse or common-law partner, please describe their English or French language ability below:

English Ability:
Listen HighModerateBasicNot at all	Speak HighModerateBasicNot at all	Read HighModerateBasicNot at all	Write HighModerateBasicNot at all

French Ability:
Listen HighModerateBasicNot at all	Speak HighModerateBasicNot at all	Read HighModerateBasicNot at all	Write HighModerateBasicNot at all

Have you (the principal applicant) completed at least two academic years of full-time study (in a program of at least two years in duration) at a secondary or post-secondary institution in Canada? Yes No

If yes, provide details of this study below (Name and address of school, dates of attendance, the field of study and the degree or certificate received, if any):

Has your accompanying spouse or common-law partner (other than a permanent resident residing in Canada or a Canadian citizen) completed at least two academic years of full-time study (in a program of at least two years in duration) at a secondary or postsecondary institution in Canada? Yes No

If yes, provide details of this study below (Name and address of school, dates of attendance, the field of study and the degree or certificate received, if any):

Have you completed at least one year of full-time work in Canada authorized under a work permit (or under R186) in an occupation that is listed in NOC Skill Level 0, A, or B? Yes No

If yes, provide details of this work below (Name and address of employer, dates of employment, job title, and job duties):

Has your spouse completed at least one year of full-time work in Canada authorized under a work permit (or under R186)? Yes No

If yes, provide details of this work below (Name and address of employer, dates of employment, job title, and job duties):

Do you, or your accompanying spouse or common-law partner, have a relative (parent, grandparent, child, grandchild, child of a parent, sibling, child of a grandparent, aunt or uncle, or grandchild of a parent, niece or nephew) who is residing in Canada and is a Canadian citizen or permanent resident? Yes No

If yes, provide details of these relatives below (name, address, phone number, relationship to the principal applicant or the spouse):

INADMISSIBILITY ISSUES

Security Grounds

Have you ever: (a) engaged in an act of espionage or an act of subversion against a democratic government, institution or process as they are understood in Canada; (b) engaged in or instigated the subversion by force of any government; (c) engaged in terrorism; (d) been a danger to the security of Canada; (e) engaged in acts of violence that would or might endanger the lives or safety of persons in Canada; or (f) been a member of an organization that there are reasonable grounds to believe engages, has engaged or will engage in the above acts? Yes No

Human or International Rights Violations

Have you ever: (a) committed an act that may constitute a crime against humanity or a war crime; (b) been a senior official in the service of a government that engages or has engaged in terrorism, systematic or gross human rights violations, or genocide, a war crime or a crime against humanity; or (c) been a person whose entry into or stay in Canada is restricted pursuant to a decision, resolution or measure of an international organization of states or association of states, of which Canada is a member? Yes No

Criminal Grounds

Have you ever been arrested, charged, or convicted of any offence or crime, inside or outside Canada, even though the subject of a pardon, amnesty, expungement, or other similar legal action? Yes No

Organized Crime

Have you ever: (a) been a member of an organization that is believed on reasonable grounds to be or to have been engaged in activity that is part of a pattern of criminal activity planned and organized by a number of persons acting in concert in furtherance of the commission of any offence or crime, whether inside or outside Canada; or (b) engaged, in the context of transnational crime, in activities such as people smuggling, trafficking in persons or money laundering? Yes No

Health Grounds

Is your health condition: (a) likely to be a danger to public health; (b) likely to be a danger to public safety; or (c) something that might reasonably be expected to cause excessive demand on health or social services? Yes No

Misrepresentation

Are you inadmissible for misrepresentation: (a) for directly or indirectly misrepresenting or withholding material facts relating to a relevant matter that induces or could induce an error in the administration of Canada's citizenship or immigration laws; or (b) for being or having been sponsored by a person who is determined to be inadmissible for misrepresentation? Yes No

Violation of the Immigration and Refugee Protection Act (IRPA)

Have you ever failed to comply with any provision of the IRPA or any other Canadian immigration law? Yes No

Inadmissible Family Members

Is one or more of your family members inadmissible on grounds of inadmissibility described above? Yes No

If you answered "yes" to any of the above questions, please provide details below:

FIANCE(E)/SPOUSE/COMMON-LAW PARTNER/CONJUGAL PARTNER INFORMATION

If you are engaged, married, have a common law partner, or have a conjugal partner, please provide the following details regarding your fiance(e), spouse, common law partner, or conjugal partner, please answer the following questions on their behalf (your spouse, common-law partner, or conjugal partner should also complete a separate Canadian immigration questionnaire):

Their E-mail Address (It is essential that this address be correct):

Their E-mail Address (Enter your email again):

Their Family Name:

Their First Name:

Their Middle Name:

Other Names Used by Them (If married woman, give maiden and surnames of any previous spouses):

Their Birthdate (Month/Date/Year):

Their City & Country of Birth:

Citizenships Held by Them:


Their Sex (M/F): Male Female

Their Street and Suite Number:

Their City:

Their State:

Their Zip Code

Their Home Phone:

Their Business Phone:

Their Fax:

Have they ever applied for Canadian permanent residence? Yes No

If yes, provide details below:

Do they have a parent or grandparent who was born in or is a citizen of
Canada? Yes No

If yes, provide details below:

CHILDREN INFORMATION

First Child's Name:

First Child's City and Country of Birth:

First Child's Birthdate (MM/DD/YY):


Second Child's Name:

Second Child's City and Country of Birth:

Second Child's Birthdate (MM/DD/YY):


Do you have any other children? If so, please list their name, city and country of birth, and birthdate below:

PLEASE READ THE FOLLOWING STATEMENTS PRIOR TO SUBMITTING YOUR QUESTIONNAIRE. SUBMISSION OF THIS QUESTIONNAIRE INDICATES THAT YOU ACCEPT THE FOLLOWING TERMS:

1. You confirm that, to the best of your ability, you believe that the information contained in this questionnaire is truthful and correct.
2. You confirm that the submission of this questionnaire does not create any obligation for yourself or for the lawyer with whom you wish to request a formal consultation.
3. You confirm that submission of this questionnaire does not create an attorney-client relationship and that the lawyer is not obliged to schedule a consultation with you.