Form view – Canadian Provincial Nominee & Immigration Services

← Go back

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Skilled Worker
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mrs.
First Name	Dina
Last Name	Mardiyanti
Place of Birth	Kudus
Country of Citizenship	Indonesia
EDUCATION	Bachelor's Degree
Other Eduction	Bachelor in Education for Elementary Education Teacher
Current Occupation	Self Employed
Occupation in Years	Teacher
Occupation in Months	Self Employed
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Good
French	Fair
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mr.
First Name	Warsito
Last Name	Warsito
Birth Date (m/d/y)	12041976
Place of Birth	Pati
Country of Citizenship	Indonesia
N.B. Additional information on your spouse (if applicable), i.e. education, work experience could be provided on extra Space below	Bachelor Degree in Education. 13 years experienced as Village Government Headman. Managed Village Government Administration and developed the village in many sectors. He has experienced in Elementary School for 2 years.
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Muhammad Ulung Cakra Wardana
Date of Birth (mm/dd/yyyy)	31012005
Place of Birth	Pati
2. Name	Nourille Aisya Calrawardana
Date of Birth (mm/dd/yyyy)	13082008
Place of Birth	Pati
3. Name	Iffat Akila Cakrawardana
Date of Birth (mm/dd/yyyy)	21072009
Place of Birth	Pati
DO YOU HAVE ANY RELATIVES IN CANADA?	No
WHERE DO YOU INTEND TO LIVE IN CANADA?	WHERE DO YOU INTEND TO LIVE IN CANADA?
City/Town	Any city or town
Province	Any Provinces
UPLOAD RESUME	Resume_Dina1-converted.pdf
CONTACT DETAILS	CONTACT DETAILS
Address	Desa Pasuruhan Rt 3 RW 1 Kec. Kayen Kab. Pati
Contact Number	(628) 533-8528
Email Address	Email hidden; Javascript is required.