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 Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 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
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