Law Offices of Charles W. Pley — CANADA AND USA IMMIGRATION LAWYERS

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Thank you for your interest in our services. Below is a preliminary questionnaire to help us to assess your prospects for the immigration benefit you are seeking. It takes on average 10 - 15 minutes to complete and submit this form. We appreciate your patience and cooperation.

All information you provide is treated in the strictest confidence. We will provide you an overview of immigration options relevant to your circumstances. We will also provide you, if appropriate in the circumstances, a list of issues to be addressed, processing times, a copy of our retainer agreement including a clear statement of our fees and terms, and an outline of the next steps, should you wish to proceed.

Please allow 3 – 5 days for a response.

Confidential Preliminary Questionnaire

Destination of Interest:

Canada

USA

Both

Immigration Benefit Sought:	Employment Status	Student Status	Permanent Resident Status
	Citizenship/Naturalization	Other

(If other, Please provide details in the Comments Box at the end of the form)

Full Name of Applicant (as in passport):

Surname:		Given names:
E-mail Address:		Country of Current Residence:

Date of Birth:

Citizenship(s):

Sex:

Male Female

Marital Status:

Have children:

Yes No

How many:

Ages:

, , , , ,

Do you have reason to believe you may have a claim to USA or Canadian citizenship? Yes No

If yes, please provide details:

Please list your relatives in Canada or the USA:

Relationship (eg. blood uncle, spouse, fiancé..)	City of Residence in USA/Canada	Immigration Status

Education:
Do you have at least 12 years total combined of primary and secondary education? Yes No
If no, how many years combined primary and secondary education do you have?

Post - Secondary Education:

Degrees or Certificates (eg. B.Sc. "Chemistry")	Name of School/City	# Years of Study	Year of Graduation

Education of Spouse (including common-law partner):
Does your spouse have at least 12 years total combined of primary and secondary education? Yes No
If no, how many years combined primary and secondary education does he/she have?

Post - Secondary Education of Spouse:

Degrees or Certificates (g. B.Sc. "Chemistry")	Name of School/City	# Years of Study	Year of Graduation

Please List any Professional Licenses/ Memberships/ Publications or Awards you have received:

Have you been accepted to study at a school in Canada or the USA? Yes No
If yes, please provide:

Name of the School/Location	Program of Study	Start Date of Studies

Language Ability:

English:

Fluent Well Difficulty None

French:

Fluent Well Difficulty None

TOEFL Score:		Date of Test:
IELTS Overall Band Score:		Date of Test:

Employment Experience:

Most Recent Job or Business:

Dates (From/To)	Employer	Location	Job Title

Please summarize main duties/responsibilities you performed in this job:

If you owned part of the business or managed the business, please provide:

your % ownership		gross sales last year
profit/loss last year		# employees

Previous Job or Business: (1)

Dates (From/To)	Employer	Location	Job Title

Please summarize main duties/responsibilities you performed in this job:

If you owned part of the business or managed the business, please provide:

your % ownership		gross sales last year
profit/loss last year		# employees

Previous Job or Business: (2)

Dates (From/To)	Employer	Location	Job Title

Please summarize main duties/responsibilities you performed in this job:

If you owned part of the business or managed the business, please provide:

your % ownership		gross sales last year
profit/loss last year		# employees

Previous Job or Business: (3)

Dates (From/To)	Employer	Location	Job Title

Please summarize main duties/responsibilities you performed in this job:

If you owned part of the business or managed the business, please provide:

your % ownership		gross sales last year
profit/loss last year		# employees

Do you currently have a job offer in Canada or the USA? Yes No
If yes, please provide details:

Name of Employer/Location	Type of Business	Job Title	Proposed Start Date

Is your Employer in Canada or the USA a related company to your current Employer? Yes No

Are you planning to make an investment in Canada or the USA? Yes No
If yes, please provide details:

Amount of the proposed investment
What type of business or investment will be made
location of investment
your % ownership
if you will be active in the business, your position/title

If you are interested in Permanent Resident Status only, your approximate Personal Net Worth (total assets minus liabilities):

Comments or Special Requests:

Optional: How did you first find out about our law firm?

	Referral
	Please provide the name of the person/firm who referred you to us:
	Search engine
	Please specify:
	Advertisement
	Please specify publication:
	read one of your articles or saw you at a speaking engagement
	Please specify:
	Other
	Please specify: