INITIAL ASSESSMENT QUESTIONNAIRE

CLIENT FILE NUMBER

If you have been given a client file number by your Migration agent, record it here:

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MAIN APPLICANT'S INTENTIONS

Do you have any family members who will be included as part of this application?

Yes

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MAIN APPLICANT'S DETAILS

Insert your personal details:

Your Full Name

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Preferred Names

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Given Names

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Gender

Male

Female

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Insert details of when and where you were born:

Date of Birth

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Current Contact Details:

Insert details of your current telephone and email contact details: Phone Country Code

Phone

After Hours

Country Code

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Office Hours

Country Code

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Area Code

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Number

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Area Code

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Number

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Mobile/Cell #

Country Code

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Number

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Citizenship Details

Are you currently or have you been a citizen of any country?

Yes

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Insert details of the citizenship:

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Employment Details

Are you currently employed in a paid position?

Yes

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Provide details of your current employment status and your employment history since leaving school:

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Education

Have you ever undertaken, completed, or enrolled in any form of study, education or occupational training?

Yes

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List all your education and qualifications you have undertaken or are enrolled in since birth

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Language Skills

Have you undertaken an English language proficiency test in the last 36 months?

Yes

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Insert details of all official English language skills tests that you have undertaken: Type of English Langauge Test Date of

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Is the English language your first language?

Yes

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Insert details of all languages you are able to communicate in (including English):

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Occupational Registration / Licensing / Professional Membership

Do you hold any occupational registration,

Yes

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CHILDREN

Do you or your Spouse have any Children, Step Children or Adoptive Children?

Yes

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You are required to provide details about all of your and your Spouse's Children (including step-children and adoptive children):

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Is this Child currently or have they ever been a citizen of any Country or State?

Yes

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DEPENDANT FAMILY MEMBERS

Do you or your Spouse have any other Dependant family members?

Yes

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Insert this Dependant's personal details:

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FAMILY SPONSOR QUESTIONS

Is this application to be sponsored by a relative or family member?

Yes

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Please confirm your Sponsor's details:

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QUESTIONS FOR ALL INCLUDED APPLICANTS

For you and everyone who is to be included in this application, please answer the following questions:

Does every applicant who is to be included in this application live at your current residential address?

Yes

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For each applicant, provide details of their current Residential Address:

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Does every applicant who is to be included in this application currently have the same postal address?

Yes

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Australian Visas

Has anyone who is to be included in this application previously applied for or held an Australian Visa?

Yes

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Provide details of all Australian visas applied for or held by everyone who is to be included in this application:

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Travel to Australia

Is anyone who is to be included in this application currently in Australia?

Yes

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Provide details of the current stay in Australia

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Does anyone who is to be included in this application have any planned travel to Australia?

Yes

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Provide details of all proposed travel to Australia:

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Health Questions

For you and everyone who is to be included in this application, please answer the following questions regarding health:

Has anyone who is to be included in this application undertaken a health examination for an Australian visa in the last 12 months?

Yes

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Name of included Applicant Date Completed Country of Examination HAP ID (If available)

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Character Issues

For you and everyone who is to be included in this application, please answer the following questions regarding character:

Has anyone who is to be included in this application applied for a Police Clearance Certificate in the last 12 months?

Yes

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Name of included Applicant Issuing Country Date of Application Date of Issue Reference Number

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Has anyone who is to be included in this application previously been in Immigration Detention

Yes

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Name of included Applicant Date From (dd/mm/yyyy) Date To (dd/mm/yyyy) Country of Detention Please provide details

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Submit