CLIENT REGISTRATION FORM - QUINTE IMMIGRATION (ENGLISH)

First Name *

Last Name *

City

This field is optional if concerned with privacy.

Postal Code

This field is optional if concerned with privacy.

Phone *

Email *

Do you prefer to be served in English or French? *

Status in Canada *

UCI Number *

Date of Birth

This field is optional if concerned with privacy.

Gender *

Male

Female

Other

Do you identify as a member of the LGBTQ+ community? *

Yes

No

How did you hear about QUIS? *

Friends / Family

Yellow Pages

Internet

OtherOther

Would you like our office to contact you about special events? *

Yes

No

Preferred method of contact?

Phone

Email

Check Email, Phone or Both

Would you like our office to contact you with information about employment? *

Yes

No

Preferred method of contact for employment information?

Phone

Email

Check Email, Phone or Both

Place of Landing

Date of Landing

Birth Country *

Mother Tongue *

Languages Spoken *

CLB/IELTS Level

Highest Education Level (e.g. university, college, high school, elementary school) *

Area of Study

Country of Study

Marital Status *

Name of Spouse

Spouse's Country of Residence

Children *

Yes

No

Children Information, if relevant (e.g. names, ages)

Do you have any special needs? *

Yes

No

Details of special needs

Do you intend to become a Canadian citizen? *

Yes

No

Unsure

Not Applicable

Employment Status *

Employed

Unemployed

OtherOther

If Employed or Other Occupation, type in box

Intended Occupation

Work Experience in Canada

Years

Type of Work

NOC Code (if known)

Work Experience Outside Canada

Years

Type of Work

NOC Code (if known)

Are you currently enrolled in a course/school/program? *

Yes

No

If Yes, please give details

Other diplomas or courses

Intention of settling in the Quinte region? *

Yes

No

Referred to *

Privacy Policy, Consent Form and Disclaimer of Liability

Quinte Immigration Services is a non-governmental, non-profit agency. While we do receive funding from the Government of Canada and the Government of Ontario, we are not a government office or agency. Our services are provided free of charge for all. These include orientation and information on how to navigate the complex immigration system but should not be construed as legal advice or counselling. QUIS is not liable for any Immigration, Refugees and Citizenship Canada (IRCC) decisions or delays on applications filed or application processing times, changes in immigration rules while files are being processed, or follow up between IRCC and the client.

It is the responsibility of the client to follow up on any communication received from the IRCC regarding his or her file.
Personal information collected will only be used by authorized persons to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose considering the following exception:

As a part of our contribution agreements with those government bodies we may be required to share a portion of the information collected for statistical funding purposes. This information may include your name, address, date of entry in Canada, Citizenship and Immigration Canada Client Number, or Social Insurance Number. Any other information not relevant to this purpose is confidential and will not be disclosed without your prior consent.
We are committed to protecting your personal information by making reasonable security arrangements against such risks as unauthorized access, collection, use, disclosure or disposal. Security measures are integrated into our day-to-day operating practices as part of our continuing commitment to the protection of your personal information.

*

I have read and accept the above terms under which services will be provided. By typing my name and clicking ‘Submit’ I am accepting the above terms.

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