Assesment

This is not an official Government form but has been designed by us to give us all the information to assess your eligibility to meet your immigration objective. All information received with this application will be treated in the strictest confidence and will not be passed on to any third party without your permission.

We aim to provide a response to every fully completed on-line assessment within three normal business days. If you are currently staying in Auckland or can easily travel there then you are welcome to a personal assessment with an adviser. Appointments are required. A fee applies and will be rebated against our normal temporary or resident application fee if you choose to use our services. Contact us to find out what will be provided in the personal assessment.

1

Applicant Information

Family Name:
Given Names:
Gender:
Date of Birth:
Country of Birth:
Phone Number:
Mobile Number:
Fax Number:
Email Address:
Citizenship(s):
Marital Status:
If in a relationship, how long?:
Ever divorced?:
If divorced, what date:
Postal Address:
Physical Address:

2

Spouse/Partner Information

Family Name:
Given Names:
Date of Birth:
Country of Birth:
Citizenship(s):
Ever divorced?:
If divorced, what date:

3

New Zealand

Currently in New Zealand
If you have answered Yes please complete the fields below.
	Arrival Date	Permit Expiry Date	Permit Type
Applicant:
Spouse/Partner:
Child 1:
Child 2:
Child 3:
Child 4:

4

Children

Please list the names of all children ever born to you and your spouse or adopted by you and your spouse, including any and all children from previous marriages. We also need to know whether you have custody of the children where applicable.
Name	Date of Birth	Gender	Country of Residence	Citizenship	Custody
Applicant's Children




Spouse's / Partner's Children

5

Countries

Please list all countries you, your spouse and any children aged 17 or over but under 25 have spent a total of 12 months in (not necessarily consecutively) in the last ten years including your current country of residence. Please list the countries and the dates you/your spouse/children aged under 25 and 17 or over were there.eg. Canada 2005-09-11 to 2005-09-20

Applicant:
Spouse / Partner:
Child 1:
Child 2:
Child 3:
Child 4:

Has any person associated with this application spent 5 years or more in any country since their 17th birthday? If so which country/ies?

Name

Country

Dates in Country

6

Criminal Convictions

Do you or your spouse (or any children accompanying you aged 17 or over) have any criminal convictions (include traffic offences but not parking tickets)?
Any criminal convictions:
If you have answered Yes please provide brief details of who has the offences, convictions(s), the date of the conviction and the penalty imposed by the courts.
Details:

7

Family Details

Please list the details of your immediate family who are still living *including parents, brothers and sisters only*. Include half brothers and sisters. Start your family up the top of the table and your spouse's/partner's family below.
Name	Date of Birth	Gender	Country of Residence	Citizenship	Marital Status
Applicant's Family






Spouse's / Partner's Family

8

Applicant's Educational Details

Number of years of Primary/Junior schooling:
Number of years of High School/Secondary schooling:
Please list all your qualifications including schooling.
Qualification Type: Degree / Diploma / Apprenticeship/etc.	Institution	Graduation Month & Year	Full-time or Part-time	Start Date	Completion Date

9

Applicant's Work Experience

Date of Employment	Hours worked per week	Country employment was gained	Company Name	Job Title	Job Description

Can you provide evidence of all this work experience by way of official service records or letters of reference?:
Can all this work experience be independently verified if necessary?:

Please advise which employer or employment period you cannot document by way of official company records or cannot be verified.
Date of Employment	Hours worked per week	Company Name	Job Title

If any of this work experience was gained outside of your home country i.e. your place of usual residence, did you hold an appropriate permit to allow you to work lawfully?:

Date of Employment	Hours worked per week	Company Name	Job Title

10

Spouse's/Partner's Education Details

Number of years of Primary/Junior schooling:
Number of years of High School/Secondary schooling:
Please list all your qualifications including schooling.
Qualification Type: Degree / Diploma / Apprenticeship/etc.	Institution	Graduation Month & Year	Full-time or Part-time	Start Date	Completion Date

11

Spouse's/Partner's Work Experience

Date of Employment	Hours worked per week	Country employment was gained	Company Name	Job Title	Job Description

Can you provide evidence of all this work experience by way of official service records or letters of reference?:
Can all this work experience be independently verified if necessary?:

Please advise which employer or employment period you cannot document by way of official company records or cannot be verified.
Date of Employment	Hours worked per week	Company Name	Job Title

If any of this work experience was gained outside of your home country i.e. your place of usual residence, did you hold an appropriate permit to allow you to work lawfully?:

Date of Employment	Hours worked per week	Company Name	Job Title

12

Health

Do you or any person associated with this application have any medical condition that requires regular medication?:
Have you or anyone associated with this application had any medical condition in the past ten years for which you/they have been referred to a specialist?:
If yes please list the details of the condition, its cause if you can, any treatment received at the time, any current treatment and an expected prognosis.:
Has any person associated with this application spent time in hospital during the past five years for any reason what so ever?:
If yes please give details:
Do you or any person associated with this application have any intellectual disability or learning disability?:
If yes please give details:

13

English Ability

Applicant's English Language Ability
Is English your mother tongue?:
Do you hold a three year Tertiary i.e. post compulsory schooling level qualification for which the medium of instruction was English?:
If English is not your mother tongue how would you describe your English?:
Spouse's / Partner's English Language Ability
Is English your mother tongue?:
Do you hold a three year Tertiary i.e. post compulsory schooling level qualification for which the medium of instruction was English?:
If English is not your mother tongue how would you describe your English?:

14

Offer of Employment

Applicant's Offer of Employment
Do you have an offer of employment in New Zealand?:
Name of the business:
The position you hold or have been offered:
The total pre-tax salary / remuneration package:
The location (Which city or town):
The date you started working or expect to start working:
Spouse's / Partner's Offer of Employment
Do you have an offer of employment in New Zealand?:
Name of the business:
The position you hold or have been offered:
The total pre-tax salary / remuneration package:
The location (Which city or town):
The date you started working or expect to start working:

Please fill in the antispam code:

Information

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Applicant's Offer of Employment

Spouse's / Partner's Offer of Employment