Criminal Background Questionnaire Criminal Background Questionnaire File Information Name * Name First First Last Last Email * Current residential address: * Current residential address: Current residential address: Current residential address: City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Date of birth: Country of birth: * Citizenship(s): * Indicate all charges you have ever received, even if you were underage and even if it did not lead to a conviction (withdrawn, dismissed, conditional discharge, suspended etc). * Indicate all convictions you have ever received, even if you were underage and even if it did not lead to a conviction (withdrawn, dismissed, conditional discharge, suspended sentence, etc.). Provide the full and complete legal name of the conviction as per the law/statute/regulation/documentation you received. * Do you have your complete court documentation related to your charges/convictions which outline all the details (judgments, orders, decisions etc)? * Yes No If you do not have these documents, are you able to obtain them by contacting the relevant court (s) or by hiring the services of a local criminal lawyer? * Yes No If you have these documents and they are not in English, do you have certified translations of them? * Yes No They are already in English Indicate the full sentence you received. * Have you completed the entirety of your sentence? * Yes No When did you complete all sentences? * Do you have proof that you have completed the entirety of your sentence (release documentation, proof completion of sentence, letter from probation officer, receipt of payment of all fines etc.)? * Yes No Do you currently have any pending charges against you? * Yes No Do you currently have any warrant for arrests against you or think you might have one? * Yes No Where did the offence(s) occur? Please list all countries, states/provinces the offence(s) occurred? * If the offences occurred in Canada, have you inquired when you would be eligible for a Record Suspension with the Parole Board of Canada? * Briefly describe to us the circumstances of your life at the time of the offence (s) – what led you to the criminal offence (financial reasons, emotional difficulties, wrong crowd, bad decisions, lapse of judgment etc.). * How can we best help you? Please indicate any other special information about which you believe would be relevant to us to know pertaining to your case? What is the thing that stresses you the most about your immigration matter? reCAPTCHA If you are human, leave this field blank. Submit
