SKILLED MIGRATION QUESTIONNAIRE
Country:
 PERSONAL DETAILS
Surname:
First Name:
Date Of Birth:
Place Of Birth:
Postal Address:
Home Telephone:
Work Telephone:
Fax:
Zip:
E-mail:

Names of Dependents Date of Birth Relationship
Do you have a serious health problem ? No  Yes
Do you have a criminal record ? No  Yes
  Full Details of your educational history
Mark %
Name of all Qualifications Obtained
Name of School/College/University
Country
PERIOD OF STUDY
FROM
TO
MTH - YEAR
MTH - YEAR

  Full details of your employment history/current employment/training
Period of Employment/ Training (mm/yyyy)
Name & Address of Employer/Trainer
Business Conducted by Employer/Trainer
Brief Description of Duities/Training
 From:
     To:
English language proficiency: Fluent   Medium   Limited
Do you have a Qualification demonstrating
Professional Language Skills in any language?
No   Yes
If 'Yes', please state language(s)