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Clare Form
It is important that you answer every question. If you are unable to answer any question, make a note of it and provide the information once you have obtained it. If a question does not
apply to you or your application, write N/A. Use an X mark where applicable. The information you supply us will help us conduct an initial assessment of your application. Please use
additional sheet if necessary. You may also send us pertinent documents, e.g. resume. Submit this form to the Case Assessment Office.

Your Name (Surname, First Name, Middle Name)

NYADE, THOMAS KWESI

All other names you may have used (e.g. maiden name)
N/A

Sex: Male ✔ / Female Height Eye colour

1.71 M BROWN

Nationality Country of permanent residence

GHANAIAN GHANA

Date of birth (year, month, day) Place of birth (city/town, province/state, country)
1998/09/13 GHANA

Permanent address DOMPOASE SHS, SKILLED VALIDATION CODE (SVC)

BLOCK B4, C A / S V C1 0 0 6 8 9 2 7 5 / 2 1
KUMASI,GHANA
Telephone number Cell phone number
+233556838026 +233556838026

Mailing address E-mail address

[email protected] [email protected]
Telephone number Cell phone number
+233556838026 +233556838026

Your current marital status

Never married ✔ Married Widowed Legally separated
Divorced Annulled marriage Common-law Others
If you selected others, please elaborate.

If you are currently married or in common-law relationship, when did you got married or started a common-law relationship? (year, month, day)
N/A
If you have been married or in common-law relationship before, provide the following:
Name of previous spouse or common-law partner (surname, first name, middle name)
N/A
Married Common-law From (year, month, day) To (year, month, day)

Passport number Country of issue Expiry (year, month, day)

G3457243 GHANA 2031/11/23

Your current occupation (National Occupational Classification) Intended destination in Canada

UNEMPLOYEDIntended Job - In Canada E1311 NOVA SCOTIA
Immigration Assessment Form (Continuation…) Page 2 of 9

How well can you communicate in English?

Speak Read Write Listen
High proficiency ✔ High proficiency ✔ High proficiency ✔ High proficiency ✔
Medium proficiency Medium proficiency Medium proficiency Medium proficiency
Low proficiency Low proficiency Low proficiency Low proficiency
No proficiency No proficiency No proficiency No proficiency

How well can you communicate in French?

Speak Read Write Listen
High proficiency High proficiency High proficiency High proficiency
Medium proficiency Medium proficiency ✔ Medium proficiency Medium proficiency
Low proficiency ✔ Low proficiency Low proficiency ✔ Low proficiency ✔
No proficiency No proficiency No proficiency No proficiency

What is your native language?ASANTE TWI

Total number of years of school successfully completed (primary, secondary, undergrad, post-grad)
16

Your level of educationBACHELOR'S DEGREE

No secondary Secondary Trade/vocational Certificate/diploma
Some years in post-secondary, no degree Bachelor’s degree Master’s degree Doctorate degree

Spouse or common-law partner Dependent child 1 Dependent child 2

Surname N/A N/A N/A
First name N/A N/A N/A
Middle name N/A N/A N/A
Sex N/A N/A N/A
Date of birth
(year, month, day) N/A N/A N/A
Place of birth
(city, province, country) N/A N/A N/A
Country of citizenship N/A N/A N/A
Country of permanent residence N/A N/A N/A
Marital status N/A N/A N/A
Will accompany you to Canada Yes No Yes No Yes No
Current occupation N/A
Total number of years of formal
education N/A
Level of education attained N/A
Can communicate in English Yes No Yes No Yes No
Immigration Assessment Form (Continuation…) Page 3 of 9

Can communicate in French Yes No Yes No Yes No

Native language N/A
Height N/A
Eye colour N/A
Complete residential address at
present N/A

Dependent child 3 Dependent child 4 Dependent child 5

Surname N/A N/A N/A
First name N/A N/A N/A
Middle name N/A N/A N/A
Sex N/A N/A N/A
Date of birth
(year, month, day) N/A N/A N/A
Place of birth
(city, province, country) N/A N/A N/A
Country of citizenship N/A N/A N/A
Country of permanent residence N/A N/A N/A
Marital status N/A N/A N/A
Will accompany you to Canada Yes No Yes No Yes No
Current occupation N/A
Total number of years of formal
education N/A
Level of education attained N/A
Can communicate in English Yes No Yes No Yes No
Can communicate in French Yes No Yes No Yes No
Native language N/A
Height N/A
Eye colour N/A
Complete residential address at
present N/A

How will you finance yourself when you come to Canada? Will you have sufficient funds or will a person, an employer or an organisation assist you?
SELF FINANCE
Amount of settlement funds you have (in CAD $):N/A
Do you or your accompanying spouse or common-law partner have any relatives living in Canada? If you do, please provide full name, address and
relationship.
N/A
Immigration Assessment Form (Continuation…) Page 4 of 9

Have you or your spouse or common-law partner worked full-time in Canada? If you have, please provide employer name, position and duration of
employment.
N/A

Have you or your spouse or common-law partner previously completed a full-time study of at least 2 years at a post-secondary institution in Canada?
If you have, please provide name of institution, course and duration of schooling.
N/A
Have your, or if you are the principal applicant, your family members listed here ever:
Been convicted, or are currently charged with, on trial for, or party to a crime or offence, or subject of any criminal Yes No ✔
proceedings in any country?
Previously sought refuge refugee status in Canada or applied for a Canadian immigrant or permanent resident visa or visitor Yes No ✔
or temporary resident visa?
Been refused refugee status in, or an immigrant or permanent resident visa or visitor or temporary resident visa, to Canada Yes No
✔
or any other country, or have been refused a Certificate de selection du Quebec (CSQ) to Quebec?
Been refused admission to, or ordered to leave, Canada or any other country? Yes No
✔
Been involved in an act of genocide, a war crime or in the commission of a crime against humanity? Yes No ✔

Used, planned or advocated the use of armed struggle or violence to reach political, religious or social objectives? Yes No
✔
Been associated with a group that used, uses, advocated or advocates the use of armed struggle or violence to reach Yes No ✔
political, religious or social objectives?
Been a member of an organisation that is or was engaged in an activity that is part of a pattern of criminal activity? Yes No ✔

Been detained or put to jail? Yes No

✔
Had any serious disease or physical or mental disorder? Yes No ✔

Please provide details to questions you answered “Yes”

Have you changed your name? Yes No ✔

If your name is different on any of your transcripts or identity documents, you will need to send us a certified true copy of a ‘proof of name
change’ document.
You can prove your name has changed by documents such as a marriage certificate or government-issued change of name document.
Please ensure that these are certified true copies of the original documents.

Select the provinces you will like to reside in. A nomination certificate will be issued from the selected providence

Alberta
British Columbia
Manitoba
New Brunswick ✔
Newfoundland ✔
Nova Scotia ✔
Ontario ✔
Prince Edward Island ✔
Saskatchewan
Territory: Northwest Territories
Territory: Nunavut
Territory: Yukon
Immigration Assessment Form (Continuation…) Page 5 of 9

Scan and upload your educational certificate here (1)

Immigration Assessment Form (Continuation…) Page 6 of 9

Scan and upload your educational certificate here (2)

Immigration Assessment Form (Continuation…) Page 7 of 9

Scan and upload your educational certificate here (3)

Immigration Assessment Form (Continuation…) Page 8 of 9

Scan and upload your educational certificate here (4)

Immigration Assessment Form (Continuation…) Page 9 of 9

Scan and upload your educational certificate here (5)