Queven, LLC

Quebec Selection Certificate

Eligibility Questionnaire

Principal Applicant:
Applicant Manick Rendon Email: Manickr2002@yahoo.com
Name:
Permanent Maguyepyep, Sallapadan, Abra
Residence:
Current Residence (if different from P. O. Box 250-899 Riyadh 11391 Saudi Arabia
above):

Highest Level of College Age 40

Education: :
Area of Physical Therapy Year 1997
Training: Graduated:

Do you have a validated offer of employment Yes No no

from Quebec:
If Yes, indicate Within Metropolitan Outside Metropolitan Montreal
location: Montreal

Work # of 120 Internshi # of

Experience: Months: + ps: Months:
Have you or your spouse ever visited Quebec in the Yes No no
last 10 years?
If yes, purpose of # of
visit: Months:

Spouse/Common-law Partner (if applicable):

Spouses N/A Email:
Name:
Highest Level of Age
Education: :
Area of Year
Training: Graduated:
Work # of Internshi # of
Experience: Months: ps: Months:

Family in Quebec:
Spouse Son/Daughter; Father/Mother; Grandpare Uncle/ Aunt; Nephew
Brother/Sister nts /Niece
Brother( Vancouver Canada)
Accompanying Children:
Number of children 12 years of age or Number of children 13 to 21
younger years of age

Settlement Fund:
Has the required Settlement Fund to live in Quebec without work Yes ye No
upon arrival? s
(General settlement funds requirement: $2,800 for the principal applicant plus $1,300 for each accompanying
family member.)

Language Proficiency:
French (Oral Comprehension) Applica Spous French (Oral Expression) Applica Spous
Federal Skilled Worker Class
Eligibility Questionnaire
Page 2 of 2

None
Minimal (levels 1 and 2)
Beginner (levels 3 and 4)
Intermediate (levels 5 and 6)
Intermediate advanced
(levels 7 & 8)
Advanced (levels 9 to 12)
nt e nt e
none None none
Minimal (levels 1 and 2)
Beginner (levels 3 and 4)
Intermediate (levels 5 and 6)
Intermediate advanced
(levels 7 & 8)
Advanced (levels 9 to 12)

English (Oral Comprehension) Applica Spous English (Oral Expression) Applica Spous
nt e nt e
None None
Beginner (levels 1 to 4) Beginner (levels 1 to 4)
Intermediate (levels 5 to 8) Intermediate (levels 5 to 8)
Advanced (levels 9 to 12) adv Advanced (levels 9 to 12) adv

Please return completed form to: inquiry@queven.net

Rev.09.21.11

Revised: 06.30.11