ASCAN CONSULTANTS LTD.	[Approved by Ministry of Labor, Govt. of  India]

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Company Structure Business Associate Feed Back Contact		ASCAN Consultants Limited, a world leader in Immigration Services, would be assessing your eligibility for Immigration, and you would be informed accordingly.

CANADA         AUSTRALIA         NEW ZEALAND         OTHER (Specify) SECTION A (To be completed by applicant) Full Name Sex Last Name    First Name    Male Female Date of Birth Country                                 Citizen of Day  12345678910111213141516171819202122232425262728293031  Month  123456789101112  Year    Current Mailing Address Permanent Address Phone  Email  Phone  Email  Marital Status Never MarriedEngagedMarriedWidowedSeparatedDivorcedAnnulled Marriage Do you or your spouse have relatives in country of your choice. If yes, please give details: Name Relationship Address Phone No. E-mail Status (Citizen or Permanent Resident) ---------SpouseFiance(e)PatnerParentsGrandchildrenBrotherSisterNephewNieceUncleAunt ---------CitizenPermanent Resident Please provide details of your education(academic,professional or technocal) from matric / secondary school onwards with dates, names and addresses of Institutions attended, courses taken and degree / diploma / certificate received. Indicate all full time and part time courses.Please avoid using abbreviations. From M. Yr. To M. Yr. Name and Address of Institutions Course Taken (Subjects) Diploma / Degree / Certificate Full / Part-time / Correspondence ---------FullPart-timeCorrespondence ---------FullPart-timeCorrespondence ---------FullPart-timeCorrespondence Please provide detailed employment record with dates, names & addresses of employers and job designations held From M. Yr. To M. Yr. Name & Addresses of employers Job Designations Full / Part-time ---------FullPart-time ---------FullPart-time ---------FullPart-time Please give detailed description of job responsibilities you performed since you started working. Please describe the job responsibilities that you performed on day-to-day basis. Please indicate your ability to communicate in English (Please tick () the appropriate column) ENGLISH FRENCH Fluent Well With Difficulty Not At All Speak Read Write Understand Fluent Well With Difficulty Not At All Speak Read Write Understand Did you or your spouse ever completed one year or more full-time work experience in country of your choice, with an Employment Authorization? If yes, please complete following information Name of Employer Address / Telephone # Occupation / Designation Duration From Duration To Did you or your spouse ever completed minimum of two years of two years of full time post secondry study in country of your choice, with Student Authorization? If yes, please complete following information Name of Educational Institute Address / Telephone # Courses Attended Duration From Duration To Did you or your spouse have an offer of employment in country of your choice, which would be effective upon your arrival? If yes, please complete following information Name of Employer Address Telephone # Job Designation Offered Do you or your spouse have Arranged Employment in country of your choice approved by Human Resources Development? if yes, please complete following information Name of Employer Address / Telephone # Job Designation Offered From To Have you ever owned and operated your own business? Yes     No   If yes, please enter a complete business profile of your company. Your current Monthly Income Net worth   (Assets less Liabilities) Do you or any of your dependents (i.e. spouse and children) have any serious medical conditions? If yes, please state name of the person and give brief detail SECTION B (To be completed by applicant) Full Name Date of Birth Day  12345678910111213141516171819202122232425262728293031  Month  123456789101112  Year  Sex Country of Birth Citizenship Male    Female  Please provide details of your spouse's education(professional or technocal) from matric / secondary onwards with dates, names and addresses of Institutions attended, courses taken and degree / diploma / certificate received. Indicate all full time and part time courses.Please avoid using abbreviations. From M. Yr. To M. Yr. Name and Address of Institutions Course Taken (Subjects) Diploma / Degree / Certificate Full / Part-time / Correspondence ---------FullPart-timeCorrespondence ---------FullPart-timeCorrespondence ---------FullPart-timeCorrespondence Please provide your spouse's detailed employment record with dates, name & address of employers and job desgnations held From M. Yr. To M. Yr. Name & Addresses of employers Job Designations Full / Part-time ---------FullPart-time ---------FullPart-time ---------FullPart-time Please give detailed description of job responsibilities performed during working. Please describe the jpb responsibilities that were performed on day-to-day basis. Please indicate your ability to communicate in English (Please tick () the appropriate column) ENGLISH FRENCH Fluent Well With Difficulty Not At All Speak Read Write Understand Fluent Well With Difficulty Not At All Speak Read Write Understand SECTION C (To be completed for your children) Provide details of all your children Full Name Date of birth Day  12345678910111213141516171819202122232425262728293031  Month  123456789101112  Year  Day  12345678910111213141516171819202122232425262728293031  Month  123456789101112  Year  Name of Introducer How did you come to know about ASCAN I declare that information given in this form is true, completed and correct and to the best of my knowledge.

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