one-EKA Consultants (Canada) Inc.
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Your Pathway to Canada
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Screening - Information About You
Name
*
First or Given Name(s)
Last Name/Family or Surname
Country Code
*
Phone Number
*
Format: (000) 000-0000.
Current Address
*
Street Address Line 2
City
*
Area
State / Province
*
Postal / Zip Code
*
Country
*
Email Address
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Place of Birth
*
Gender Identity
*
Male
Female
Prefer Not to Say
Other
Applicant's Family Information
Married (includes Common-Law)
*
Please Select
Yes
No
Date of Union
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse's Name (if applicable)
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Children
*
Please Select
Yes
No
# of Children
Name of Child and Gender
First Name - Male/Female
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Child and Gender
First Name - Male/Female
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have any immediate family member(s) in Canada?
*
Yes
No
Main Applicant's Education History
Main Applicant's Educational
*
Secondary/College/University/Post-Graduate
Name of Last School Graduated from
Date Completed/Last Attended
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Main Applicant's Employment/Work History
Name of Company
*
Position
*
Company Address
Phone
Format: (000) 000-0000.
Date Employed
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Main Applicant's Language Abilities
Language Abilities
*
English
French
Other
Have You Completed IELTS
*
Yes - Academic
Yes - General
Still Preparing
No
IELTS Test - Listening
Band 7-8
Band 6
Band 5
Band 4
Other
IELTS Test - Reading
Band 7-8
Band 6
Band 5
Band 4
Other
IELTS Test - Writing
Band 7-8
Band 6
Band 5
Band 4
Other
IELTS Test - Speaking
Band 7-8
Band 6
Band 5
Band 4
Other
What countries have you traveled to outside your own?
Canada
The United States
Mainland Europe
England
UAE
Australia / New Zealand
South America
Eastern Asia
Other
Any additional information that you can provide?
Keep you comment brief, please.
Request for an Appointment (Eastern Standard Time -5:00) [NOTE* Appointments must be scheduled at least two days in advance)
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