Ann Arbour Consultants Inc.

Tel: 647 477 2197

(Legal and immigration Services) Fax: 647 477 5983
4117 Lawrence Avenue E, Suite 205-14 Email:
annabour@rogers.com
Toronto, ONT, Canada, M1E 2S2
Web: www.annarbour.com

EVALUATION FORM FOR SKILLED WORKER CLASS

(Forms for other classes will be emailed upon request)

COMPLETE RESIDENTIAL AND/OR MAILING ADDRESS

I.Mohamed.Shafiulla,32 a moovendar ngar,old natham

road,Madurai,Tamil nadu-625014,India
Country of living: 141,Usuman bin afan st,Buraydha,Al-qassim-Kingdom
of Saudi arabia

Telephone (with country code): …00966502171050………..

Fax (with country code):……………………………………
Email: shafi_physio@yahoo.co.in

Please answer the following questions.

PERSONAL INFORMATION
Please Applicant Spouse Dependent Dependent Dependent
print 1 2 3
Clearly
Family Inathulla NIL
Name

Given Mohamed.Sh
name afiulla

Date of 29/08/1980
birth
D/m/yr
Country of India
birth
Country of India
citizenship
Country of Saudi arabia
residence
Sex (M/F) Male
Marital Un married
Status
Current Physiotherapi
Occupatio st
n
Total 18 ½ yrs
years of
education
Native Tamil
language
Passport E-9078551
No.
Passport 29/04/2014
expiry
date

If more than 3 dependents, state how many

________________________

APPLICANT’S EDUCATIONAL HISTORY (just enter number of

years)

Years of Years of Years of Years of formal

Elementary/Primary Secondary University Training
school Or High Or College And
School Apprenticeship
8yrs 6yrs 4yrs 6 months internship

APPLICANT’S DETAILS OF POST SECONDARY EDUCATION

(University, College &
Apprenticeship Training)

From: To: Name of Institution City & Type of Degree/

Month/Y Month/Y Country Diploma/Certifica
ear ear te
1998/08 2003/08 Pioneer college of Ramnad,I Bachelore of
Physiotherapy ndia Physiotherapy

APPLICANT’S WORK EXPERIENCE SINCE 18TH BIRTHDAY

From: To: Name of Occupation Title Country

Mo/Yr Mo/Yr Employer/Company with brief job
description
2003/09 2004/09 Mahatma Clinical India
Hospitals,Madurai, physiotherapist

2004/09 2005/09 M.K hospitals,Gampola Incharge Srilanka

 physiotherapist

2005/10 2007/09 Asiri Surgical Srilanka

Hospital,Colombo Clinal
Physiotherapist

2007/10 2010/01 Mahatma Senior India

Hospitals,Madurai, physiotherapist

2010/01 Till date Central security Senior Saudi

hospital,al-qassim physiotherapist arabia

SPOUSE’S EDUCATIONAL HISTORY (just enter number of years)

Years of Years of Years of Years of formal

Elementary/Primary Secondary University Training
school Or High Or College And Apprenticeship
School
N/A

SPOUSE’S DETAILS OF POST SECONDARY EDUCATION (University,

College & Apprenticeship Training)

From: To: Name of Institution City & Type of Degree/

Month/Y Month/Y Country Diploma/Certifica
ear ear te

N/A

SPOUSE’S WORK EXPERIENCE SINCE 18TH BIRTHDAY

From: To: Name of Occupation Title Country

Mo/Yr Mo/Yr Employer/Company with brief job
description
N/A
HAS THE MAIN APPLICANT or SPOUSE EVER STUDIED IN
CANADA? IF SO GIVE DETAILS OF COLLEGE/UNIVERSITY
ATTENDED AND NUMBER OF YEARS ATTENDED
Nil

HAS THE MAIN APPLICANT or SPOUSE EVER WORKED IN

CANADA? IF SO GIVE DETAILS OF EMPLOYERS ‘ NAME AND
ADDRESS AND DATES EMPLOYED.
Nil

HAS THE MAIN APPLICANT AND/OR SPOUSE BEEN OFFERED

EMPLOYMENT IN CANADA? Or IS IT POSSIBLE TO OBTAIN AN
OFFER FROM CANADA. IF SO GIVE FULL DETAILS OF EMPLOYER,
POSITION OFFERED, IF OFFER WAS ACCEPTED AND IF YOU ARE
ABLE TO OBTAIN THE OFFER IN WRITING.
Nil
APPLICANT’S LANGUAGE PROFICIENCY (Please check mark with
“X”)

ENGLISH FRENCH
Spea Read Writ List Spe Rea Write Liste
k e en ak d n
High proficiency
Moderate
proficiency
Low proficiency
No proficiency
IELTS Score: List: 7 ,Read: 6,WritIng: 5.5, Speaking 5.5.

SPOUSE’S LANGUAGE PROFICIENCY (Please check mark with

“X”)

ENGLISH FRENCH
Spea Read Writ List Spe Rea Write Liste
k e en ak d n
High proficiency
Moderate
proficiency
Low proficiency
No proficiency

RELATIVES IN CANADA (grandparents, parents, siblings,

children, grandchildren, uncle/aunt, niece/nephew)

Name of Relative NIl

Address in Canada
Telephone Number
Relationship to applicant or spouse

Amount of funds available to bring in to Canada (Can $)

For Business Applicants:

Name of Business:
Nature of Business:

No of years in Existence:

No of Employees:

Value if assets of business(Can$):

Your personal net worth (Can$):

Amount of funds available to bring to Canada: