FREE IMMIGRATION ASSESSMENT

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					     THE
 Au st r al i an



                               IMMIGRATION ASSESSMENT
 Immigration             _______________________________________________________________
     P   L   A   C   E




                                        CLIENT QUESTIONNAIRE

A.               PERSONAL DET AILS
Family Name
First Name                                                            Middle Name
Date of Birth                           /       /                     Citizen of


B.               CONTACT DETAILS
Residential Address




Email                                                                          Mobile no.

C.               DOCUMENTATION
Passport no.                                                          Passport expiry                     /      /
Visa type held                                                        Visa expiry                     /         /




D.               STATUS
Dependent:               
Marital Status:              Never Married      Married         De facto         Divorced         Separated 

Spouse details:
NAME OF SPOUSE / PARTNER                                                                         DOB (DD/MM/YEAR)
                                                                                                      /         /
NAME OF CHILDREN (please provide details of ALL dependent children)                              DOB (DD/MM/YEAR)
Child 1                                                                                               /         /
Child 2                                                                                               /         /
Child 3                                                                                               /         /
Child 4                                                                                               /         /


Do you have ANY other children from a previous marriage or relationship?                    YES              NO 
Do you have any person over the age of 25 years who is dependent upon you? YES                               NO 


E.               CLOSE RELATIVES

Do you or does your spouse have any close relative(s) in Australia?

Grandparent(s)                  Parent       Brother/Sister      Aunt/Uncle        First Cousin   
Where do these relatives live in Australia? Please list name, state and suburb OR town.
                                                                        Immig.Status               Suburb or Town,
Name of relative(s)                               Relationship
                                                                        AC , PR, Other             State
1.
2.
3.




Client Questionnaire for Assessment by The Australian Immigration Place                                       Page 1   of 5
F.     EDUCATION
       (Start from most recent post-secondary vocational or tertiary qualification)


          EDUCATION PROVIDER                                   Academic details
          (incl. address & tel no.)                                                         Date commenced
                                                                                               (dd/mth/yr)
 1.   Name:                                             Subjects studied & level of pass:
                                                                                                /       /

      Address:
                                                                                             Date completed
                                                                                              (dd/mth/yr)

                                                                                                /       /
      Country:                                                      Achieved


      Tel. no:                                                                              Full-time   
      Website
                                                                                            Part-time   
          EDUCATION PROVIDER                                   Academic details
          (incl. address & tel no.)                                                         Date commenced
                                                                                               (dd/mth/yr)
 2.   Name:                                             Subjects studied & level of pass:
                                                                                                /       /

      Address:
                                                                                             Date completed
                                                                                              (dd/mth/yr)

                                                                                                /       /
      Country:
                                                                    Achieved
      Tel. no:                                                                              Full-time   
      Website
                                                                                            Part-time   
          EDUCATION PROVIDER                                   Academic details             Date commenced
          (incl. address & tel no.)                                                            (dd/mth/yr)

 3.   Name:                                             Subjects studied & level of pass:       /       /


      Address:
                                                                                             Date completed
                                                                                              (dd/mth/yr)

                                                                                                /       /
      Country:
                                                                    Achieved

      Tel. no:                                                                              Full-time   
      Website
                                                                                            Part-time   
          EDUCATION PROVIDER                                   Academic details
          (incl. address & tel no.)                                                         Date commenced
                                                                                               (dd/mth/yr)
 4.   Name:                                             Subjects studied & level of pass:
                                                                                                /       /

      Address:
                                                                                             Date completed
                                                                                              (dd/mth/yr)

                                                                                                /       /
      Country:                                                      Achieved


      Tel. no:                                                                              Full-time   
      Website                                                                               Part-time   



Client Questionnaire for Assessment by The Australian Immigration Place                     Page 2   of 5
G.      ENGLISH LANGUAGE

Have you undertaken an IELTS test?         YES         NO REPEATING 

Date of the most recent IELTS test: _____ / ______ / _________

List individual IELTS band scores and the overall score below:

Listening             Reading               Writing             Speaking           Overall Band Score




H.      HEALTH

Do you currently suffer from or have you suffered from any significant medical conditions? YES         NO 
If YES, provide details (what, when, how treated, likelihood of recurrence etc)




_________________________________________________________________________________________

________________________________________________________________________________________


Does any member of your family or any child of yours from a previous relationship suffer from any significant
medical condition?                                                                          YES        NO 
If YES, provide details (what, when, how treated, likelihood of recurrence etc)




_________________________________________________________________________________________

________________________________________________________________________________________


I.      CHARACTER

Have you or any member of your immediate family ever been convicted of ANY criminal offence in any country?
                                                                                            YES        NO 
If YES, provide details (what, when, how treated, likelihood of recurrence etc)




J.      AUSTRALIAN VISA

Have you or any member of your immediate family been REFUSED an Australian visa OR had an Australian
Visa CANCELLED?                                                                             YES        NO 
If YES, provide person’s name, visa type, date (dd/mm/yr) of refusal/cancellation.




K.      MILITARY SERVICE or INTELLIGENCE AGENCY

Have you or any member of your immediate family ever served in the military forces of any country OR been
employed by an intelligence agency in any country?                                          YES        NO 
If YES, provide details (nature of service, when, duration, rank)
_________________________________________________________________________________________

_________________________________________________________________________________________



Client Questionnaire for Assessment by The Australian Immigration Place                            Page 3   of 5
L.       SKILLED or EMPLOYER SPONSORED MIGRATION

If you are a candidate for SKILLED or EMPLOYER SPONSORED Migration, please attach a detailed resume.

If your spouse has qualifications and work experience, include a separate resume for him/her.

WORK EXPERIENCE

Include all jobs held, with most recent first:
                Name and address of employer
                Dates from and to (dd/mm/yy)
                Job title
                Full description of duties and responsibilities
                Who you report to and how many reported to you.



M.       RELATIONSHIP VISA

If you are a applying for a RELATIONSHIP VISA, tick the appropriate box

a)    Prospective Spouse          Spouse          DeFacto Spouse            Interdependent (Same sex)

b)   Write an outline of the development of your relationship since you and your partner first met. Include dates
     (dd/mm/yy) and places you went to. Give as much detail as the space permits. Attach another page if you
     do not have enough room.


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Client Questionnaire for Assessment by The Australian Immigration Place                            Page 4   of 5
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




I certify that the answers I have given on this Client Questionnaire are true and correct.



Name: _____________________________________________________



Signature: __________________________________________________



Date: ______________________________________________________




        THE
       Au st r al i an

                              Level 1, 95 Burwood Road
                              Burwood NSW 2234, AUSTRALIA
                              PO Box 22, Burwood NSW 1805
                              Ph: 61 2 9744 5100        Fx: 61 2 9715 2460
      Immigration             E: DavidCoote@TheAustralianImmigrationPlace.com
        P   L   A   C   E     W: www.TheAustralianImmigrationPlace.com




Client Questionnaire for Assessment by The Australian Immigration Place             Page 5   of 5

				
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