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C
C
CONFIDENTIAL
EVALUATION WORKSHEET
Ref №
OD TS Sem Other
Section 1 ~ PLEASE READ THESE NOTES
How did you hear about the Brazolot Migration Group?
This form must be completed before we can advise you about any aspect of your relocation. Please complete all
sections carefully and legibly in dark ink. If you have a CV we will be interested to receive this also, but please still
complete all sections of the form.
Our fee for the assessment is GBP£39.00 / Euro€50.00 / USD$65.00. Payment should be forwarded with the form (see page 4).
Once we have received your details we will assess your eligibility against the emigration laws of your chosen
destination(s). We can then advise you about the right strategy for making an application and developing your
career. We will normally respond to you with the results of your assessment within seven working days.
An informal consultation would normally follow a positive assessment, at no further charge and with no obligation.
One of our migration specialists will be pleased to discuss your plans, explain the intricacies of the Residence
application process and answer any further queries about your potential destination. You will receive further
information concerning a residency application with the results of your assessment.
The information requested on this form is essential to provide an assessment of your eligibility for attaining
residency overseas, and will be treated in the strictest confidence. The Brazolot Migration Group Inc. cannot accept
any responsibility for an assessment and subsequent application made from information, which is untrue or
misleading in any way.
Section 2 ~ PERSONAL DETAILS
First Name
Middle Name(s)
Family Name / Surname
Name of principal applicant
Mr. / Mrs. / Ms. / Miss / Dr. (please circle)
Name of spouse / partner
Mr. / Mrs. / Ms. / Miss / Dr. (please circle)
(further information about your spouse / partner is requested on page 4)
Home address
Postal code
Country
Home telephone number
Birthplace
Mobile telephone number
Birthplace (Parents)
Which passport(s) do you hold?
Date of birth
Marital Status
Age
Height
ft / m
dd / mm / yyyy
lbs / kg
Weight
E-mail address(es)
Section 3 ~ CHILDREN
First Name/Surname if different
Date of birth
Working?
Student?
Emigrating with you?
dd / mm / yyyy
yes
no
yes
no
yes
no
dd / mm / yyyy
yes
no
yes
no
yes
no
dd / mm / yyyy
yes
no
yes
no
yes
no
dd / mm / yyyy
yes
no
yes
no
yes
no
The Brazolot Migration Group Inc. {BMG} W: brazolotgroup.com, E: [email protected]
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ
T: +1 45Ø 458 2186, F: +1 45Ø 458 2848
Section 4 ~ EDUCATION - ACADEMIC, TRADE & PROFESSIONAL QUALIFICATIONS
Did you obtain any formal qualification from secondary school?
yes
page 2 of 4
no
What age did you START primary school?
years old
What age did you FINISH secondary school?
years old
Qualification achieved
e.g. 'O' levels, CSE,
GCSE, 'A' levels, Highers
Name of School
start
Month / Year
finish
Month / Year
Did you undertake any further education after leaving school?
Apprenticeships(s)
e.g. C. & G.'s, SCOTVEC's,
N.V.Q.'s etc.
Diploma or
College Course
e.g. H.N.C.'s/H.N.D.'s,
BTEC's etc.
Degree(s)
e.g. Bachelors', Master's,
P.H.D.'s
start
Month / Year
finish
Month / Year
start
Month / Year
finish
Month / Year
start
Month / Year
finish
Month / Year
start
Month / Year
finish
Month / Year
yes
no
Subject
Qualification
Subject
Qualification
Subject
Qualification
Subject
Qualification
Other
Section 5 ~ YOUR EMPLOYMENT (Last 10 years, most recent first)
Name of Employer, Type of Industry etc…
from
Month / Year
to
Month / Year
Total
yrs.
/
Full
Time /
Part
Time
mths.
Name of Employer, Type of Industry etc…
from
Month / Year
to
Month / Year
Total
yrs.
/
mths.
from
Month / Year
to
Month / Year
yrs.
/
Job Title, Description, Main Duties etc…
Full
Time /
Part
Time
Name of Employer, Type of Industry etc…
Total
Job Title, Description, Main Duties etc…
Job Title, Description, Main Duties etc…
Full
Time /
Part
Time
mths.
Have you organised employment in your destination country?
yes
no
Would you require assistance in finding employment?
yes
no
Would you be able to start new employment in 25 weeks time?
yes
no
Would you consider a career change? i.e. studying in Canada
yes
no
If yes please provide details
continue on separate sheet if necessary
Section 6 ~ LANGUAGES
Ability in ENGLISH
fluent
well
difficulty
Habileté en français
none
avancé
intermédiaire
débutant
aucune
Ability in:
specify
fluent
difficulty
Speak
Read
Write
Listen
The Brazolot Migration Group Inc. {BMG} W: brazolotgroup.com, E: [email protected]
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ
T: +1 45Ø 458 2186, F: +1 45Ø 458 2848
well
none
Section 7 ~ FINANCIAL STATUS
page 3 of 4
Indicate currency used i.e. GBP£ / Euro€ / USD$
Use this area for any notes about your assets
Property equity (value less mortgage)
Savings / investments (excl. pension)
Cars & vehicles (value less finance)
Redundancy payment expected
Other
MINUS outstanding debt
continue on separate sheet if necessary
TOTAL
Do you (or your partner) own a business?
yes
no
Are you (or your partner) a senior executive in a major business?
№ of Employees?
yes
Approx. turnover?
no
Would you (or your partner) like to run your own business, or be self employed?
Section 8 ~ OVERSEAS FAMILY
Approx. turnover?
yes
no
continue on separate sheet if necessary
(Please list any family members living in CANADA, Australia, New Zealand, South Africa and U.S.A.)
1st Family Member
2nd Family Member
3rd Family Member
Principal
Principal
Principal
Name of Relative
Family Relationship
(i.e. Aunt, Brother, 1st Cousin etc.)
Relative of :
Principal Applicant or Partner
Partner
Partner
Partner
Which country /city do they reside?
Are they a citizen, permanent resident
or temporary resident
Section 9 ~ YOUR FUTURE PLANS
Assuming you are eligible for CANADA, please indicate your level of interest:
Very Keen/want to go now
Have you visited Canada?
Do you have a preferred area /
province you wish to settle in?
Keen/probably would go
yes
no
If so, when?
yes
no
Where?
Interested but undecided
Why do you wish to immigrate to Canada?
continue on separate sheet if necessary
Would you like us to pass on your details to our trusted Colleagues/Partners who can assess you for other countries?
yes
no
Australia
Our colleagues & partners who practice immigration in these countries may have an additional assessment
fee. You will be advised of any charges before an assessment is carried out.
New Zealand
South Africa
U.S.A.
Assuming you are eligible please indicate your level of interest:
Australia
Very Keen/want to go now
Keen/probably would go
undecided
New Zealand
Very Keen/want to go now
Keen/probably would go
undecided
South Africa
Very Keen/want to go now
Keen/probably would go
undecided
U.S.A.
Very Keen/want to go now
Keen/probably would go
undecided
Section 1Ø ~ EMIGRATION HISTORY
Have you previously held a visa for another country?
yes
no
Have you ever been denied/refused a visa for another country?
yes
no
if yes to either question please provide details
continue on separate sheet if necessary
The Brazolot Migration Group Inc. {BMG} W: brazolotgroup.com, E: [email protected]
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ
T: +1 45Ø 458 2186, F: +1 45Ø 458 2848
Section 11 ~ YOUR PARTNER'S PERSONAL DETAILS
First Name
page 4 of 4
Middle Name(s)
Family Name / Surname
Name of spouse / partner
Mr. / Mrs. / Ms. / Miss / Dr. (please circle)
Birthplace
Birthplace (Parents)
Mobile telephone number
Date of birth
Which passport(s) do you hold?
Age
ft / m
Height
dd / mm / yyyy
lbs / kg
Weight
E-mail address(es)
Section 12 ~ YOUR PARTNER'S QUALIFICATIONS
Did you undertake any further education after leaving school?
start
Month / Year
finish
Month / Year
yes
no
Subject
Qualification
Subject
Qualification
Qualification #1
start
Month / Year
finish
Month / Year
Qualification #2
Section 13 ~ YOUR PARTNER'S EMPLOYMENT
Name of Employer, Type of Industry etc…
from
Month / Year
to
Month / Year
Total
yrs.
/
Full
Time /
Part
Time
mths.
Place of Employment, Type of Industry etc…
from
Month / Year
to
Month / Year
Total
yrs.
/
Job Title, Description, Main Duties etc…
Job Title, Description, Main Duties etc…
Full
Time /
Part
Time
mths.
Section 14 ~ YOUR PARTNER'S LANGUAGES
Ability in ENGLISH
fluent
well
difficulty
Habileté en français
none
avancé
intermédiaire
débutant
aucune
Ability in:
specify
fluent
difficulty
well
none
Speak
Read
Section 15 ~ PAYMENT DETAILS
Our fee for the assessment is GBP£39.00 / Euro€50.00 / USD$65.00.
Payment needs to accompany this form
I have enclosed:
GBP£39.00
Euro€50.00
USD$65.00
Cheque or postal order (payable to the Brazolot Migration Group)
Visa
Mastercard
I hereby acknowledge that my fee will be converted to the equivalent in Canadian Dollars if paying by credit card
Card Number
Exact Name on Card
Expiry Date:
mm / yy
The information requested on this form is essential to provide an assessment of your eligibility for attaining Permanent or Temporary Residence in Canada and/or other countries, It will be treated with the
strictest confidence. No responsibility can be accepted by the Brazolot Migration Group of affiliated companies and/or Partners for an assessment and subsequent application made from information which is
untrue or misleading in any way.
I hereby state that the information contained in this form is, to the best of my knowledge, an accurate and truthful statement of my (and my partners) past and current situation.
Signed
Date:
Worksheets NOT signed and dated may be discarded
The Brazolot Migration Group Inc. {BMG} W: brazolotgroup.com, E: [email protected]
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ
T: +1 45Ø 458 2186, F: +1 45Ø 458 2848