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SKILLED ASSSESSMENT FORM
Confidential when Filled
Application For Free Assessment Form
(For Professional & Skilled Workers- Independent Class)
FOR CANADA/ AUSTRALIA/NEW ZEALAND/USA/UK/DENMARK
Please answer all questions carefully in block letters or use typewriter. If space is insufficient continue your answer on a separate sheet.
Please ensure that you attach a detailed Resume with this application. Please complete applicable Sections.
Full Name*: Mr./Ms./Mrs.
Sex* :
Date of Birth *
Country of Birth
Citizen of
Male Female
Current Mailing Address:
Ph. (Home)
Ph. (Off)
Mobile
Email ID
Office Address* :
Ph. (Home)
Ph. (Off)
Mobile
Email ID
Never Married
Married
Engaged
Separated
Marital Status
Divorced
Do you or your spouse have relative in Canada/Australia/New Zealand/USA/UK Europe (Spouse, Finance (e), Partner, Parents, Grandparents, Grandchildren,
Brother, Sister, Nephew, Uncle and Aunt)? If Yes, please give details:
Address
Status in
Blood Relationship









Name









Country









If relative is in Australia
Canada/Australia/New Zealand
(Related to you asǥ.)
(Specify Postal Code)






(Citizen or Permanent Resident)






Provide details of your Post-Secondary Education (Academic, Professional or Technical) from Matric Secondary School onwards with dates, names and address of
institutions attended, courses taken up and degree/ Diploma/ Certificate received. Indicate all full time courses*:
To
From
Diploma
Name and Address of Institutions
Recognized
Courses Taken
% of Marks
Full/ Part Time/
/Degree/
(School/Collage) & University




















or Not




















(Subject)












Obtained




















Correspondence




















M




















Yr.


















M




















Yr.




















Certificate




















(A)
Please Provide detailed employment record with Dates, Names & Address of employers and designation held*:
To
From
Name and Address of Employers




















Designation




















Full/Part Time/ Correspondence




















M




















Yr.




















M




















Yr.




















(B)
Industry Type
(C)
Reporting Person’s Designation & KR
(D)
People in the Department
(E)
Directly Report to Applicant
Please give detailed description of job responsibilities you (Applicant) performed, since you started working. Please describe the job
(F)
responsibilities that you performed on day-to-day basis (Please attach a separate sheet if required):
ATWICS/QMS/OP/FRM-002 - Skilled Assessment Form
Version 1.1| Dated: 03th July 2019
Page 1
SKILLED ASSSESSMENT FORM
Please Indicate your ability to communicate in English and French (Please tick (√) appropriate column):
With
Not at
With
Not at
Fluent










Well










Fluent










Well










Difficulty










all










Difficulty










all










SPEAK
SPEAK
ENGLISH
READ
FRENCH
READ
WRITE
WRITE
UNDERSTAND
UNDERSTAND
Did you or your spouse ever complete one year or more full-time work experience in Canada/ Australia/ New Zealand/ USA/ UK with an Employment Authorization? If
yes, please complete following information:
To
From
Address & Telephone
Name of Employers



Designation



Full/ Part Time



Nos.



M



Yr.



M



Yr.



Did you or your spouse ever complete minimum of two years or more full-time post-secondary study in Canada/ Australia/ New Zealand/ USA/ UK with an Employment
Authorization? If yes, please complete following information:
To
From
Name and Address of
Course Taken
Diploma/Degree/
Full/ Part Time/
Institution



(Subjects)

Certificate



Correspondence



M



Yr.



M



Yr.



Did you or your spouse have arranged Employment in Canada/ Australia/ New Zealand/ USA/ UK/ approved by Human Resources Development Canada/ Australia/ New
Zealand/ USA/ UK? If yes, please provide complete following information:
To
From
Name and Address of Employers



Designation



Full/ Part Time



M



Yr.



M



Yr.



(A)
Have you ever owned and operated your own business?
YES
NO
If yes, attached a complete business profile of your company and request our nearest office to send you our Business Category
(B)
Assessment Application.
Current Monthly Salary:

Monthly Income from other Sources:

Net Worth:

Did you or your spouse have arranged Employment in Canada/ Australia/ New Zealand/ USA/ UK/ approved by Human Resources Development Canada/ Australia/ New
Zealand/ USA/ UK? If yes, please provide complete following information:
Property
Share i.e.
Less
Balance
Name of the
Capital in
No. of
Sales





Gross Profit





100% of as
Liabilities



Networth



Undertaking



Business



Employees



Immovable



Movable



partner



Do you or any of your dependents (i.e. spouse and children) have any serious medical problem? If yes, please state name of the person and give
brief details:
Please mention if you have been awarded for any exceptional or significant achievement in your own field or otherwise (nationally or
internationally)

YES
NO
Is any criminal/Civil/Police Complaint case pending against you or your spouse?
ATWICS/QMS/OP/FRM-002 - Skilled Assessment Form
Version 1.1 | Dated: 03th July 2019
Page 2
SKILLED ASSSESSMENT FORM
SECTION B : (To be filled for your spouse, if applicable)
Full Name*: Mr./Ms./Mrs.
Sex* :
Date of Birth *
Country of Birth
Citizen of
Male Female
Provide details of your spouse’s Post-Secondary Education (Academic, Professional or Technical) from Matric Secondary School onwards with dates, names and
address of institutions attended, courses taken up and degree/ Diploma/ Certificate received. Indicate all full time courses.* (Please do not use Abbreviations):
To
From
Name and Address of Institutions





Courses Taken
Diploma /Degree/
Full/ Part Time/
(Subject)





Certificate





Correspondence





M



Yr.



M



Yr.



(A)
Please Provide your spouse’s detailed employment record with Dates, Names & Address of employers and designations held:
To
From
Name and Address of Employers






Designation






Full/Part Time/ Correspondence






M



Yr.



M



Yr.



(B)
Industry Type
(C)
Reporting Person’s Designation & KR
(D)
People in the Department
(E)
Directly Report to Applicant
(F)
Please give detailed description of job responsibilities your spouse performed on day-to- day basis (Please attach a separate sheet):
Please Indicate your ability to communicate in English and French (Please tick (√) appropriate column):
With
Not at
With
Not at
Fluent












Well










Fluent










Well










Difficulty










all










Difficulty










all










SPEAK
SPEAK
ENGLISH
READ
FRENCH
READ
WRITE
WRITE
UNDERSTAND
UNDERSTAND
SECTION C : (To be completed for your children)
Full Name






Date of Birth






How did you learn about ATWICS?
News Paper
Friends / Relatives
Radio
Radio
Client of ATWICS
I hereby declare that the information given in this applicable is true, complete and correct to the best of my knowledge.
Name:

Date:


Place:
ATWICS/QMS/OP/FRM-002 - Skilled Assessment Form
Version 1.1 | Dated: 03th July 2019
Page 3