3-DNETŪ - IMMIGRATION ASSISTANCE
FOR VIP MEMBERS


PRELIMINARY ASSESSMENT FORM 


 

Surname (Family Name):        

First Name:                   

Other Names are:

Your Permanent Home Address Is:
Current Address:    

City:               

State/Province:     

Country:            

Zip Code:           




Phone:   Home:      

         Business:  

         Fax:       

         Email:
Personal Information
Sex:                     Male  Female

Date of Birth (D/M/Y)      :   

City and Country of Birth :    

Country of Citizenship     :   

Present Marital Status is  :Never Married Engaged
                            Married       Widowed
                            Separated     Divorced

Relationship of my closest relative living in Canada is:
Languages

Ability in English:
Speak: Fluently Well With Difficulty Not At All
Write: Fluently Well With Difficulty Not At All
Read: Fluently Well With Difficulty Not At All

Ability in French:
Speak: Fluently Well With Difficulty Not At All
Write: Fluently Well With Difficulty Not At All
Read: Fluently Well With Difficulty Not At All


Education Details:


I have a three or four year BACHELOR degree. Yes No

Details of my Post Secondary Education

From - To
(Mo/Yr) (Mo/Yr)		 Name and Location of School/
Institute		 Type and Date of
Certificate or Diploma, Name of Speciality

Employment History

Your Work History for the Past 10 Years.



Name of Current Employer     :

Position                     :

Date Started (month/year)    :

Present Occupation           :

Duties  : Please provide a brief description of your duties in the box below










Previous Employer#1       :

Position                  : 

Date Started (month/year) :

Date Left (month/year)    :

Occupation:







Previous Employer#2       :

Position                  : 

Date Started (month/year) :

Date Left (month/year)    :

Occupation:







Previous Employer#3       :

Position                  : 

Date Started (month/year) :

Date Left (month/year)    :

Occupation:






Previous Employer#4       :

Position                  : 

Date Started (month/year) :

Date Left (month/year)    :

Occupation:






Previous Employer#5       :

Position                  : 

Date Started (month/year) :
Date Left (month/year)    :

Occupation:

Where to contact us:
The 3-D Network Company Headquarters is located in Ottawa, Canada
Phone/Fax: 1-613-761-8625
International website:http://www.3dnet.org/

Networking is a requirement for Business and Individual alike.
The ONLY security these days is how wide your network is and how shrewdly you market yourself.
3-DNETŪ can assist you!

Copyright 1996 The 3-D Network Company, Ottawa, ON, CANADA
3-DNETŪ is a registered trademark of The 3-D Network Company International Inc.