Refugee/Self Employment Assessment

Your Contact Information

First Name: Marital Status:  Unmarried
Last Name:  Married or Common-Law Partner
Email Address:
Telephone: Residence:
Spouse's Name: Citizenship:

Your Immigration Assessment

I am  years old. I have  dependent children.

Your Language Proficiency


Speak Read Write Listen

Your Education


How long in Canada

When Refuge Claim was made

Represented by Counsel

Have you had a hearing yet, if yes then when



Your Work Experience in Home Country

If you have no work experience, please indicate "None".
You can only count work experience that you have been paid for.
If most of your work experience has been part-time instead of full-time, please indicate the average hours worked per week for each job position.
Note: "Full-time Work" means at least 37.5 hours of work per week.
If your total work experience is less than 2 years, then you may wish to provide us with the starting month/year and ending month/year dates for each separate position.



Starting with the most recent, please list your last three jobs:

You may paste your resume (optional) or add further details here:

Full Job Title

Years Worked

How many years work experience do you have in the last ten years?


Your work Experience in Canada


Starting with the most recent, please list your last three jobs:


Full Job Title

Years/month Worked

Your Business/Self Employment Experience in Canada


Date started business


Main Business Activity/Describe Business




Main Ethnic Community of Operation

Number of part time employees

Number of full time employees

Gross income for the last 6 month

Type of business expenses

Monthly fixed expenses

Monthly variable expenses

Pay taxes


Own equipment/transportation




What kind of Equipment and transportation