O'Brien Migration - BOOK ONLINE

Assessment Form

Main Applicant(s):
Family Name:
Given Names:
Date of Birth:
Wife/Spouse Name:
Given Names:
Date of Birth:
Children Under 18:
Child 1
Family Name:
Given Names:
Date of Birth:
Child 2
Family Name:
Given Names:
Date of Birth:
Child 3
Family Name:
Given Names:
Date of Birth:
Other Dependants:
Family Name:
Given Names:
Date of Birth:
Address:
Residential Address:
City:
Country:
Postcode:
Postal Address: (if same write 'AS ABOVE')
Telephone:
Home:
Work:
Fax:
Mobile 1:
Mobile 2:
Family Details:
Are any of your children studying in Australia?	Yes No
Your Marital Status:	Married Single De Facto Divorced Seperated
Do you have a relative living in Australia?	Yes No
If yes, describe relationship below	Brother Sister Father Mother Uncle Aunt Other If Other,
Are they an Australian Citizen or Permanment Resident?	Yes No
How long have they lived in Australia?
Are they working?	Yes No
Language Skills:
How well do you communicate in English?	Fluently Functional Limited None
Are you fluent (speaking and writing) in any other language?
Education: Main Applicant:
School 1
Name of school
Location City
Total Years there
Qualification
School 2
Name of school
Location City
Total Years there
Qualification
School 3
Name of school
Location City
Total Years there
Qualification
Wife/Spouse:
School 1
Name of school
Location City
Total Years there
Qualification
School 2
Name of school
Location City
Total Years there
Qualification
Apprenticeship:
Trade
Name of Employer
Date commenced
Date completed
Description of duties performed
Employment or Business History:
Employment 1
Name of employer/business
Occupation
Date commenced
Date completed
Description of duties performed
Employment 2
Name of employer/business
Occupation
Date commenced
Date completed
Description of duties performed
Do you hold any employment licences, registrations or association memberships?
Previous Overseas Travel:
Have you or your children eer been to Australia?	Yes No
Visit 1
Date of arrival
Departure
Who
Visit 2
Date of arrival
Departure
Who
Visit 3
Date of arrival
Departure
Who
Have you or any member of your family ever overstayed a visa period in Australia?	Yes No
Have you or your family ever had a visa refused/cancelled?	Yes No
Do you or your family currently hold a visa for Australia?	Yes No
Do you or your family hold dual citizenship?	Yes No
Have you or your family ever been known by another name?	Yes No If Yes,
Health & Character:
Do you or your family have (or previously had) any serious illness?	Yes No If Yes, please give details
Have you or your family ever been convicted of a crime/offence, or awaiting legal action now?	Yes No
Have you or your family ever served in the armed forces?	Yes No
Are there any reasons which could delay your or your family's departure to Australia?	Yes No
Other Details:
Where in Australia would you want to live?	Victoria New South Wales Queensland South Australia Western Australia Tasmania Northern Territory ACT
What is the value of assets you intend to bring to Australia?
Have you had advice from another registered migration agent in relation to this matter?	Yes No

I declare that the information supplied above is complete, true and up to date in every detail and I understand that applications for visas based on incorrect material may be refused or cancelled.
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