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2019-01-25_a.morgan_BMGew2014-Home Care Assistance.pdf
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CCCONFIDENTIAL
Ref № EVALUATION WORKSHEET
Home Care Assistance Ref №
OD TS Sem Other
Section 1 ~ PLEASE READ THESE NOTES
How did you hear about the Brazolot Migration Group ?
This form must be completed before we can advise yo u about any aspect of your relocation. Please compl ete all
This form must be completed before we can advise yo u about any aspect of your relocation. Please compl ete all
sections carefully and legibly in dark ink. If you have a CV we will be interested to receive this als o, but please still
complete all sections of the form.
Our fee for the assessment is GBP£49.00 / Euro €60.00 / USD$75.00. Payment should be forwarded with the form (see page 4).
Once we have received your details we will assess y our eligibility against the emigration laws of your chosen
destination(s). We can then advise you about the ri ght strategy for making an application and developi ng your career. destination(s). We can then advise you about the ri ght strategy for making an application and developi ng your career.
We will normally respond to you with the results of your assessment within seven working days.
An informal consultation would normally follow a po sitive assessment, at no further charge and with no obligation.
One of our migration specialists will be pleased to discuss your plans, explain the intricacies of the Residence
application process and answer any further queries about your potential destination. You will receive further
information concerning a residency application with the results of your assessment.
Family Name / Surname Middle Name(s) First Name The information requested on this form is essential to provide an assessment of your eligibility for a ttaining residency
overseas, and will be treated in the strictest conf idence. The Bra zolot Migration Group Inc. cannot accept any
responsibility for an assessment and subsequent app lication made from information, which is untrue or misleading in
any way.
Section 2 ~ PERSONAL DETAILS
(further information about your spouse / partner is requested on page 4) Family Name / Surname
Home address Middle Name(s)
Mr. / Mrs. / Ms. / Miss / Dr. (please circle )
Mr. / Mrs. / Ms. / Miss / Dr. (please circle ) First Name
Name of principal applicant
Name of spouse / partner
Postal code
Home telephone number
Mobile telephone number Country
Birthplace
Birthplace (Parents)
Weight Which passport(s) do you hold?
Marital Status Date of birth
Age Mobile telephone number Birthplace (Parents)
Height dd / mm / yyyy
lbs / kg ft / m
First Name /Surname if different E-mail address(es)
Student? Emigrating with you?
yes yes Working?
no no no dd / mm / yyyy yes Section 3 ~ CHILDREN
Date of birth
no
The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com yes dd / mm / yyyy yes yes no no yes dd / mm / yyyy yes no no yes
no yes yes no yes no dd / mm / yyyy
no
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ T: +1 45Ø 458 2186, F: +1 45Ø 458 2848 The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com
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Qualification achieved Did you obtain any formal qualification from second ary school?
What age did you START primary school? no yes
years old Section 4 ~ EDUCATION - ACADEMIC, TRADE & PROFESSIONAL QUALIFIC ATIONS page 2 of 4
Qualification achieved
e.g. 'O' levels, CSE,
Name of School
yes GCSE, 'A' levels, Highers What age did you FINISH secondary school? years old
Did you undertake any further education after leavi ng school? start
finish Month / Year Month / Year
no yes Did you undertake any further education after leavi ng school?
Diploma or start no
Qualification Apprenticeships(s)
e.g. C. & G.'s, SCOTVEC's,
N.V.Q.'s etc.
Subject Month / Year
Month / Year Month / Year Subject
start
finish Qualification
Diploma or
College Course
e.g. H.N.C.'s/H.N.D.'s,
BTEC's etc. start
finish
finish Subject Month / Year
Degree(s)
e.g. Bachelors', Master's,
P.H.D.'s start Month / Year
Month / Year Month / Year
Qualification
Month / Year finish Qualification
start Subject finish
Month / Year
Other Month / Year
Section 5 ~ YOUR EMPLOYMENT (Last 10 years, most recent first)
Job Title, Description, Main Duties etc…
Job Title, Description, Main Duties etc… Name of Employer, Type of Industry etc…
Month / Year Month / Year
from Month / Year Name of Employer, Type of Industry etc…
yrs. / mths. from
to
Total Full
Time /
Part
Time
Job Title, Description, Main Duties etc… Name of Employer, Type of Industry etc… Month / Year
to Month / Year
Total yrs. / mths.
from Month / Year
to from
Month / Year Full
Time /
Part
Time
Full
Time /
If yes please provide details no
no
no Would you require assistance in finding employment?
Would you be able to start new employment in 25 wee ks time? yes to
yes Have you organised employment in your destination c ountry? Month / Year
Total yrs. / mths.
yes Time /
Part
Time
continue on separate sheet if necessary
well difficulty none Would you consider a career change? i.e. studying i n Canada
Ability in: Ability in ENGLISH
fluent well difficulty none yes no Would you be able to start new employment in 25 wee ks time? yes
no
avancé Section 6 ~ LANGUAGES
specify
débutant Habileté en français
aucune fluent intermédiaire
The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com well difficulty none
Listen Write fluent well difficulty none avancé
Read débutant
Speak aucune fluent intermédiaire
The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ T: +1 45Ø 458 2186, F: +1 45Ø 458 2848
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page 3 of 4
Property equity (value less mortgage)
Savings / investments (excl. pension) Indicate currency used i.e. GBP£ / Euro € / USD$
Use this area for any notes about your assets Section 7 ~ FINANCIAL STATUS
Cars & vehicles (value less finance)
Redundancy payment expected
Other
Approx. turnover ? no continue on separate sheet if necessary
Are you (or your partner) a senior executive in a major business? yes MINUS outstanding debt
TOTAL
Approx. turnover ? Do you (or your partner) own a business? yes no № of Employees?
no Are you a senior executive in a major business? yes
continue on separate sheet if necessary
1st Family Member 2nd Family Member 3rd Family Member no Would you (or your partner) like to run your own bu siness, or be self employed? yes
Name of Relative Section 8 ~ OVERSEAS FAMILY (Please list any family members living in CANADA, A ustralia, New Zealand, South Africa and U.S.A.)
Family Relationship
(i.e. Aunt, Brother, 1st Cousin etc.)
Partner Principal Partner Principal Principal
Which country /city do they reside? Name of Relative
Partner Relative of :
Principal Applicant or Partner
Interested but undecided Assuming you are eligible for CANADA , please indicate your level of interest:
Keen/probably would go Are they a citizen, permanent resident or
temporary resident
Very Keen/want to go now Section 9 ~ YOUR FUTURE PLANS
Do you have a preferred area /
province you wish to settle in? yes Have you visited Canada ? yes no If so, when?
no
Why do you wish to immigrate to Canada? Where?
continue on separate sheet if necessary
Would you like us to pass on your details to our trusted C olleagues/Partners who can assess you for other countries ?
Assuming you are eligible please indicate your level of interest: U.S.A. yes no
Australia New Zealand South Africa Our colleagues & partners who practice immigration in these countries may have an additional assessment fee .
You will be advised of any charges before an assessment is carried out.
South Africa Very Keen/want to go now undecided Assuming you are eligible please indicate your level of interest:
Keen/probably would go
Keen/probably would go New Zealand Very Keen/want to go now undecided Keen/probably would go
U.S.A. Very Keen/want to go now Keen/probably would go undecided undecided Australia Very Keen/want to go now
The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com Have you previously held a visa for another country? yes no
Have you ever been denied/refused a visa for another country? yes no if yes to either question please provide details
continue on separate sheet if necessary Section 1 Ø ~ EMIGRATION HISTORY
The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ T: +1 45Ø 458 2186, F: +1 45Ø 458 2848
--- Page 4 ---
Birthplace Birthplace (Parents) Name of spouse / partner
Mr. / Mrs. / Ms. / Miss / Dr. (please circle ) First Name Middle Name(s) Family Name / Surname page 4 of 4 Section 11 ~ YOUR PARTNER'S PERSONAL DETAILS
Weight dd / mm / yyyy
Height ft / m lbs / kg Mobile telephone number
Which passport(s) do you hold? Date of birth
Age
Qualification
start Month / Year no
Subject Did you undertake any further education after leavi ng school? yes E-mail address(es)
Section 12 ~ YOUR PARTNER'S QUALIFICATIONS
Subject Qualification
Qualification #2 finish Month / Year
Month / Year
finish Month / Year start Qualification #1 start Month / Year
Job Title, Description, Main Duties etc…
from Month / Year
to Month / Year
Total yrs. / mths. Name of Employer, Type of Industry etc… finish Month / Year
Full
Time /
Part
Time Section 13 ~ YOUR PARTNER'S EMPLOYMENT
Job Title, Description, Main Duties etc…
Total Place of Employment, Type of Industry etc…
Month / Year
Month / Year
yrs. / mths. Total yrs. / mths.
from
to Time
Full
Time /
Part
Time
none
Speak
Read Ability in ENGLISH Habileté en français Ability in:
fluent none avancé specify
difficulty débutant aucune fluent well difficulty intermédiaire well Section 14 ~ YOUR PARTNER'S LANGUAGES
Section 15 ~ PAYMENT DETAILS
USD$65.00 Our fee for the assessment is GBP £49.00 / Euro €65.00 / USD $7 5.00 .
Payment needs to accompany this form
Cheque or postal order (payable to the Brazolot Migration Group) I have enclosed: GBP£39.00 Euro €50.00 Section 15 ~ PAYMENT DETAILS
Free-of-Charge
Compliments of :
Dennis Brazolot Home Care Assistance -
Fee Waived
Visa Mastercard
mm / yy Exact Name on Card Expiry Date:
The information requested on this form is essential to provide an assessment of your eligibility for a ttaining Permanent or Temporary Residence in Canada and/or other countries, It will be treated with t he
strictest confidence. No responsibility can be acce pted by the Brazolot Migration Group of affiliated companies and/or Partners for an assessment and sub sequent application made from information which is I hereby acknowledge that my fee will be converted to the equivalent in Canadian Dollars if paying by c redit card
Card Number Dennis Brazolot
( Signature below Still Required )Fee Waived
The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com Worksheets NOT signed and dated may be discarded I hereby state that the information contained in th is form is, to the best of my knowledge, an accurat e and truthful statement of my (and my partners) pa st and current situation.
Signed strictest confidence. No responsibility can be acce pted by the Brazolot Migration Group of affiliated companies and/or Partners for an assessment and sub sequent application made from information which is
untrue or misleading in any way.
Date:
35 Wharf Road, Hudson, Québec, Canada, JØP 1HØ T: +1 45Ø 458 2186, F: +1 45Ø 458 2848 The Brazolot Migration Group Inc. {BMG} W: brazol otgroup.com, E: info@brazolotgroup.com