YOUR CANADIAN IMMIGRATION JOURNEY STARTS HERE The information provided on this form is added to file proper documentation and aid in filling government forms. Applicants are advised to avoid misleading information on this forms. I want service in *EnglishFrenchWhat travel document do you plan to use to travel to Canada? *SelectSelectPassport-Oridnary/regularPassport-diplomaticEmergency/temporary travel documentPassport-officialPassport-serviceRefugee travel documentSelectWhat is the nationality noted on this passport? *Passport number *Passport number (re-enter) *Passport year of issue *Month of issue *Day of issue *Year of expiry *Have you previously applied to enter or remain in Canada? *YesNoHave you previously apply or obtain a Canadian job offer *YesNoAre you a citizen of any other country? *YesNoPersonal Details Of ApplicantFamily name *First/Given names *Gender *MaleFemaleOtherHeight (cm) *Date of Birthday *DaySelect day12345678910111213141516171819202122232425262728293031MonthSelect month123456789101112YearSelect Year212521242123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925City/town of birth *Country/territory of birth *Marital status *Never married/SingleMarriedDivorcedCommon - LawLegally SeparatedWidowedNot ApplicableWhat was the level of education completed? *SelectSelectPhd DegreeMaster DegreeUndergraduate Diploma attesting to 3 or more years of full-time studiesUndergraduate University degree, 2 years of full-time studiesUndergraduate University degree, 1 years of full-time studiesPost-Secondary School(techical diploma), 3years of full-time studiesPost-Secondary School(techical diploma), 2 years of full-time studiesPost-Secondary School(techical diploma), 1 years of full-time studiesPost-Secondary School(general diploma), 2 years of full-time studiesSecondary school(vocational)Secondary School(general)How many years of work experience have you obtain? *Give your Job status/field of experience *Current Monthly Salary *SelectSelectUS $0-$500US $501-$1,000US $1,001-$1,500US $1,501-$2,000US $2,001-$2,500US $2,501 Or HigherNet Income (estimation) *SelectSelectUS $0-$9,999US $10,000-$24,999US $25,000-$49,999US $50,000-$99,999US $100,000-$499,000US $500,000 or MoreTelephone (Country Code + Phone) *Email address (It will be used to contact you about your application) *Street/civic number or house name *Street address/name *City/town *Country/territory *Spouse or Common-Law Partner And ChildrenDetails of first family member *E.g. Family name|given name| relationship| date of birth| marital status| citizenship| passport number| passport issued date| passport expiry dateDetails of second family member *E.g. Family name|given name| relationship| date of birth| marital status| citizenship| passport number| passport issued date| passport expiry dateDetails of third family member *E.g. Family name|given name| relationship| date of birth| marital status| citizenship| passport number| passport issued date| passport expiry dateWill accompany you to Canada? *YesNoBackground QuestionsHave you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country/territory? *YesNoHave you ever been refused a visa or permit, denied entry to, or ordered to leave Canada or any other country/territory? *YesNoIn the past two years, were you diagnosed with tuberculosis or have you been in close contact with a person with tuberculosis? *YesNoDo you have one of these conditions? *SelectSelectNon of the belowUntreated syphillsUntreated drug or alcohol additionUntreated mental health condition with psychosisConsent and Declaration:- I have read and understand the above declaration. I declare that the information I have given in this application is truthful, complete and correct. I understand that misrepresentation is an offence under section 127 of the Immigration and Refugee Protection Act and may result in a finding of inadmissibility to Canada or removal from Canada. I agree that by filling this form and clicking submit, I accept with the terms and conditions on this entity. *I agree to the terms and conditionsOtherRead our terms and conditions :- Please read the terms and conditions and our privacy Policy to learn how we strive to protect the data that you send to us and about our services; we conduct our business based on the following principles:1. We are a private entity not associated in any way with any government agency. We strive to make visitors to our platform aware that we offer an independent service to skilled worker applicants who do not want the hassle of filing government forms.2. We aim to treat all applicants with the greatest of respect. If you have a problem about our services, please email your complaint along with details to info@cohencampbellcic-ca.com marked for the attention of Susan Irizarry. We aim to deal with all disputes honestly and fairly.3. We issue refunds under specific conditions. Please email us at info@cohencampbellcic-ca.com with your refund request. Our refund policy is detailed below.4. Our application form for the immigration contain a service fee for processing. By signing the service sheet or providing required documents you accept our fee and terms of business. Our application pack contain free government forms. By filling our application pack you are paying for the additional information (processing fee) which aids the filing of the government application forms and all processing charges have to be made through Bank Transaction for a Co-proprietorship to enable Job and Work Permit procurement without any delay or hindrance. The terms and conditions for proceeding a work permit application are request to read before filling or providing any documents/requirements.5. We strive to add accurate content to our services; however government information and programs can change without notice at any time. To this end we do not accept responsibility for inaccurate information. If you find inaccuracies on our application, please let us know the section and the information you believe to be misleading or incorrect.6. All information requested for Immigration, we are strictly confidential and kept 100% private. We do not give or sell information to third parties. Each of our staff members has signed an agreement prohibiting them from sharing information about our applicants or the entity outside of the entity environment. Once we have fulfilled our business with an applicant their personal information is destroyed. We do not allow applicants invade agency privacy by calling them (except applicant is notified to do so) or by writing down personal information. All contact with our applicants is conducted via email. All emails are monitored.7. When applicant choose to go by for processing itself or for a third party agent outside our agency with guidance from our team. We do not take responsibility for information submitted by applicant, which is not true, accurate or illegible.8. Our employees responsible for processing applications use titles like Crossing Agent ” and " US Visa Agent” to describe their position in the entity. This title is not in any way related to the positions in the US/Canada government Customs and Border Protection agency who use the term “Border Crossing Officer” to describe public servants who administer regulations associated with immigration and customs control. REFUNDS POLICY. WE strive to provide every applicant with an efficient and flawless service. However we appreciate that there may be times when you wish to cancel our service. We will refund your payment in full if we have not submitted an application form or have not provided us with all of the information we need to successfully process your application.In this instance, please email us immediately at info@cohencampbellcic-ca.com. You don’t have to give a reason for your refund request, just be sure to provide us with the transaction proof so that we can trace your payment. You will receive your refund within 24 hours of us receiving your notification. You must make a refund request within 45 days of purchasing our service.We cannot make refunds when an application has been successfully submitted according to the terms and conditions outlined on the application form, which you agreed to when you submitted your application. However if you believe that we have not carried out our work according to the terms and conditions outlined on the application form please email us. We are always reasonable and we’re willing to help.We cannot refund fees paid to government agencies. To receive a refund for this fee you must contact the agency you went through directly.Applicants are advice to be patience and reliable during our service with them in other to ensure positive result with standard immigration success. *I agree to the terms and conditionsOtherSUBMIT