EBBI Express Entry Assessment — Client Intake (Blank)

How to fill this out: Write dates as Day / Month / Year (e.g. 04 / 07 / 2026). Where a question does not apply, write N/A. Print clearly in block letters. Return by mail, in person, or scan and email to admin@explorebeyondborders.ca. Expected response: 2–3 business days.

1. Personal Information

Last Name

First Name

Middle Name

Date of Birth (D/M/Y)

Citizenship / Nationality

Email Address

Phone Number

Currently Living In (In Canada / Outside Canada)

Current Status in Canada (if applicable)

2. Marital Status

Complete this section if married or common-law and your spouse/partner will be included in your Express Entry profile.

Select all that apply

SingleMarriedCommon-LawDivorcedWidowed

Spouse/Partner Full Name

Will your spouse/partner be included in your application? YesNo

Spouse/Partner's Highest Education Level

Spouse/Partner has taken an approved language test?

YesNoPlanning to take one

Spouse/Partner's Canadian Work Experience (if any)

3. Education

Highest Level of Education Completed (Less than secondary school; Secondary school (high school) diploma; One-year program at a university, college, trade or technical school; Two-year program at a university, college, trade or technical school; Bachelor's degree (three or more year program); Two or more certificates, diplomas, or degrees (one being 3+ years); Master's degree, or professional degree needed to practice in a licensed profession; Doctoral level university degree (PhD))

Country Where This Credential Was Earned

Field of Study

Have you completed an Educational Credential Assessment (ECA)?

Yes - ECA completedIn progressNo - not yet startedNot needed (Canadian credential)

ECA Issuing Organization (if completed)

ECA Completion Date (if completed) (D/M/Y)

Do you have any Canadian educational credentials? YesNo

If yes, describe the Canadian credential and institution

4. Language Proficiency - First Official Language

Language test results are valid for 2 years from the test date. Enter your raw test band scores exactly as shown on your results (e.g. CELPIP "9" per ability, IELTS "7.5" per ability). EBBI will convert these to CLB levels.

Test Type Taken

CELPIP (English)IELTS General Training (English)TEF Canada (French)TCF Canada (French)Not taken yet

Test Date (if taken) (D/M/Y)

Listening Score

Reading Score

Writing Score

Speaking Score

5. Language Proficiency - Second Official Language (Optional)

Test Type Taken

CELPIP (English)IELTS General Training (English)TEF Canada (French)TCF Canada (French)

Listening Score

Reading Score

Writing Score

Speaking Score

6. Canadian Work Experience

List all Canadian skilled work experience from the last 10 years. Work must be in NOC TEER 0, 1, 2, or 3 to count. If you have more than 3 jobs to list, describe additional ones in the Additional Information box in the final step.

Job 1 - Employer Name

Job Title

NOC Code

Start Date (D/M/Y)

End Date (leave blank if current) (D/M/Y)

Hours Per Week

Were you authorized to work during this period? YesNoUnknown

7. Canadian Work Experience - Job 2

Job 2 - Employer Name

Job Title

NOC Code

Start Date (D/M/Y)

End Date (leave blank if current) (D/M/Y)

Hours Per Week

Were you authorized to work during this period? YesNoUnknown

8. Canadian Work Experience - Job 3

Job 3 - Employer Name

Job Title

NOC Code

Start Date (D/M/Y)

End Date (leave blank if current) (D/M/Y)

Hours Per Week

Were you authorized to work during this period? YesNoUnknown

9. Foreign Work Experience

List skilled foreign work experience from the last 10 years (NOC TEER 0, 1, 2, or 3).

Job 1 - Employer Name

Job Title

Country

NOC Code (closest match)

Start Date (D/M/Y)

End Date (leave blank if current) (D/M/Y)

Hours Per Week

10. Foreign Work Experience - Job 2

Job 2 - Employer Name

Job Title

Country

NOC Code (closest match)

Start Date (D/M/Y)

End Date (leave blank if current) (D/M/Y)

Hours Per Week

11. Provincial Nomination

Have you received or applied for a Provincial Nominee Program (PNP) nomination?

Yes - already nominatedApplied, awaiting decisionNot yet applied, interestedNo / not interested

Which Province (if applicable)

12. Family Ties in Canada

Do you have a sibling (brother or sister) who is a Canadian citizen or permanent resident, living in Canada? YesNo

13. Job Offer Status

Note: as of March 2025, IRCC removed job offer points from CRS scoring. We still ask about this because a valid job offer can affect eligibility for certain programs and work permit pathways, even though it no longer adds CRS points directly.

Do you have a valid job offer in Canada?

YesNoIn discussion / not yet finalized

If yes, Employer Name and NOC Code

14. Admissibility Screening

Please answer honestly - these questions affect eligibility and require legal review if "Yes."

Any criminal conviction, anywhere, ever (even if pardoned/expunged)? NoYes

Any previous Canadian immigration refusal or removal order? NoYes

Have you had a medical exam for Canadian immigration purposes? (Completed / Scheduled / Not yet)

15. Document Status

Check all documents you currently have ready.

Documents ready — check all that apply

Valid passportECA reportLanguage test resultsProof of funds / bank statementsWork reference lettersPolice clearance certificate(s)Birth certificateMarriage certificate (if applicable)

Additional Information / Anything Else We Should Know

Client Declaration

I declare that the information provided is true, complete, and accurate to the best of my knowledge. This form is for assessment only, does not constitute legal advice, and does not guarantee any immigration outcome. I have read the Privacy Policy and Legal Notice at explorebeyondborders.ca. I authorize EBBI to share this information with supervising counsel, Atty. George M. Garvida.

☐ I have read and agree to the above declaration

Full name (print)

Signature

Date (D/M/Y)

For EBBI Staff Use Only

Received by

Date received (D/M/Y)

Reference code assigned

Pathway flagged

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