Express Entry Form – Iwajay Immigration Consulting

Express Entry Questionnaire

PERSONAL DETAILS

Given names in passport

Family name (last name) in passport

Gender

Male

Female

Date of birth

Country of Birth

City/Town of Birth

Marital Status

Marital Status (e.g. Single/Never married, divorced, separated etc.)

Applying WITH your spouse?

Yes

Is your spouse accompanying you?

Yes

Is your spouse a Canadian PR or citizen?

Yes

Spouse’s Personal Details (if Applicable)

Given name (first name) in passport

Family name (last name) as in passport

Gender

Male

Female

Date of birth

Country of Birth

City/Town of Birth

ID Document

Passport Number

Country of Issuance

Issue Date

Expiry Date

Immigration History and Citizenships

Applied to IRCC/Canadian embassy before

Yes

If YES, ever applied for Express Entry before

Yes

Your IRCC UCI number

Country (countries) of Citizenship

Country of Current Residence

Status in Country of Current Residence

Family

How many family members do you have? (this includes yourself, spouse and children)

Funds available to support family (CDN$)

Relatives in Canada (if applicable)

Relatives in Canada

Relative in Canada 18yrs+ (citizen or PR currently living in Canada )	How related?	Province/Territory where relative resides

Contact Details (Principal Applicant’s details)

Telephone number

Add additional Section

Add additional section

Languages (attach additional page for more details – if also tested in French)

Can communicate in English or French

English

French

Both

Which is used most often?

English

French

Test taken from designated test agency to assess proficiency in English

Yes

Language Test version (eg. General)

Date of Language Test

Date of Test Results

Language Test Certificate Number

Test taken (eg. IELTS, CELPIP)

Breakdown of score: (Speaking/Reading/Listening/Writing)

Add another Test

Language Test version (eg. General)

Date of Language Test

Date of Test Results

Language Test Certificate Number

Test taken (eg. IELTS, CELPIP)

Breakdown of score: (Speaking/Reading/Listening/Writing)

Application Details

Which Province or Territory to consider living in?

I authorization for CIC and Province/Territory to collect your information and share with potential employers You MUST agree to register for Express Entry

Yes

Do you have an approved Provincial Nomination?

Yes

If Yes, please upload a copy of your Provincial Certificate

I have studied full-time in Canada for 2 years or more

Yes

I have at least 2 years of full-time work experience in Canada (TEER 0, 1, 2 or 3)

Yes

I have a relative in Canada who is 18 years or older, a citizen or PR of Canada, and is my parent, child, grandparent, grandchild, sibling, aunt, uncle, niece ornephew

Yes

Occupation

Primary occupation (by NOC code)

Date first became qualified for this occupation (year/month)

Work in Canada in past 3 years

Yes

Canadian Certificate of Qualification (CoQ)

Do you possess a Canadian CoQ?

Yes

CoQ is for what Province/Territory?

5-digit NOC code of CoQ

CoQ obtained on (Date)

Date of issuance

Intended Work in Canada (if no, jump to Work history on next page)

Do you have a Job offer in Canada

Yes

Is this Job full-time non-seasonal and permanent?

Yes

5-digit NOC code of the Job

Job Title

How many employers made this Job offer (number)?

Is the employer an Embassy, Consulate or High Commission?

Yes

Is employer on list of ineligible employers with the Government of Canada?

Yes

Employer or Company name

Contact address of employer or company

Intended location of employment

Street address and Province

LMIA or Job Offer

Was a Positive LMIA issued for the job offer?

Yes

If Yes, please upload a copy of your LMIA

LMIA number

LMIA issue date

LMIA expiry date

Are you currently working in Canada?

Yes

Work History (List all work experience only in TEER 0, 1, 2 or 3 – overpast Attach additional page, ifrequired, for more details.) 10 years. Apprenticeship not included & work acquired while studying. Full time doesn’t count for CEC class.

Do you have work history?

Yes

Is this your current job?

Yes

Start Date

End Date

Hours of work per week/ Total no of months

5-digit NOC code

Job Title

Employer/company name

Self-employed

Yes

Where (Country/City) – provide full address if Canada

Add another work history

Is this your current job?

Yes

Start Date

End Date

Hours of work per week/ Total no of months

5-digit NOC code

Job Title

Employer/company name

Self-employed

Yes

Where (Country/City) – provide full address if Canada

Add another work history

Is this your current job?

Yes

Start Date

End Date

Hours of work per week/ Total no of months

5-digit NOC code

Job Title

Employer/company name

Self-employed

Yes

Where (Country/City) – provide full address if Canada

Add another work history

Is this your current job?

Yes

Start Date

End Date

Hours of work per week/ Total no of months

5-digit NOC code

Job Title

Employer/company name

Self-employed

Yes

Where (Country/City) – provide full address if Canada

Please note that dates and other details need to be a 100% accurate. Contracts, employment verification letters, pay stubs and bank statements will need to provided at a later stage.

By signing below, I confirm and attest to the ACCURACY of all information provided in this document.

Yes

SIGNATURE

TYPE NAME IN FULL

DATE signed

City/Country where Completed and Signed

Express Entry Questionnaire Submission

Kindly complete the entire form & please type N/A for all sections that don’t apply to you. If you require assistance please email help@iwajay.com with your questions.
Prior to submission of this form, please go over the entire document to ensure information provided is a 100% accurate! Applications can be refused at a later stage by the government of Canada for minor errors, inconsistencies or misrepresentation!!

Please upload the supporting documents below

Detailed resume(s)

Choose File

Passport data page(s)

Choose File

Degree/diploma certificate(s)

Choose File

WES assessment report(s)

Choose File

Language test result(s)

Choose File

Additional Information (Previous application(s) to Canada, Canadian visas/ permits, work offer letters and or contracts can be an advantage)

Choose File

Date / Time

Text Input

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PERSONAL DETAILS

Marital Status

Spouse’s Personal Details (if Applicable)

ID Document

Immigration History and Citizenships

Family

Relatives in Canada (if applicable)

Contact Details (Principal Applicant’s details)

Education (attach additional section if you have more than 1 degree and/or IF MARRIED for spouse)

Education (attach additional section if you have more than 1 degree and/or IF MARRIED for spouse)

Education (attach additional section if you have more than 1 degree and/or IF MARRIED for spouse)

Education (attach additional section if you have more than 1 degree and/or IF MARRIED for spouse)

Languages (attach additional page for more details – if also tested in French)

Application Details

Occupation

Canadian Certificate of Qualification (CoQ)

Intended Work in Canada (if no, jump to Work history on next page)

LMIA or Job Offer

Work History (List all work experience only in TEER 0, 1, 2 or 3 – overpast Attach additional page, ifrequired, for more details.) 10 years. Apprenticeship not included & work acquired while studying. Full time doesn’t count for CEC class.

Express Entry Questionnaire Submission

Contact Details

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