<% 
'*********************************************************************************************
'Formulaire pour VISA DE TRAVAIL en anglais
'Auteur :		Tony Steiner
'Date :			AVRIL 2002
'Nom Fichier :	form_work_en
'Version :		FormVisa 3.0
'Langage :		ASP
'Commentaires :	Formulaire pour visa d'immigration Canada pour travailleurs
'				Requetes pour chaque parametres entre dans les champs
'				pour validation si necessaire et envoie de donnees dans la base
'				ainsi qu'a l'evaluateur par email / candidat pour confirmation
'**********************************************************************************************

'Extraction du formulaire
lastname = replace(trim(request("lastname")),"'","''")
firstname = replace(trim(request("firstname")),"'","''")
address = replace(trim(request("address")),"'","''")
email = replace(trim(request("email")),"'","''")
age = replace(trim(request("age")),"'","''")
sex = replace(trim(request("sex")),"'","''")
marital = replace(trim(request("marital")),"'","''")
children = replace(trim(request("children")),"'","''")

FamilleAuQuebec = replace(trim(request("FamilleAuQuebec")),"'","''")
ParentQuebec = replace(trim(request("ParentQuebec")),"'","''")
FamilyInCanada = replace(trim(request("FamilyInCanada")),"'","''")
ParentsCanada = replace(trim(request("ParentsCanada")),"'","''")
AmisAuQuebec = replace(trim(request("AmisAuQuebec")),"'","''")
BeenToCanada = replace(trim(request("BeenToCanada")),"'","''")
placesdates = replace(trim(request("placesdates")),"'","''")
ReasonVisitCanada = replace(trim(request("ReasonVisitCanada")),"'","''")

elementaryyears = replace(trim(request("elementaryyears")),"'","''")
secondaryyears = replace(trim(request("secondaryyears")),"'","''")
postsecondaryyears = replace(trim(request("postsecondaryyears")),"'","''")
collegeyears = replace(trim(request("collegeyears")),"'","''")
vocationalyears = replace(trim(request("vocationalyears")),"'","''")
highestschoollevel = replace(trim(request("highestschoollevel")),"'","''")

EtudesElementaireFrancais = replace(trim(request ("EtudesElementaireFrancais")),"'","''")
EtudesSecondaireFrancais = replace(trim(request ("EtudesSecondaireFrancais")),"'","''")
EtudesPostSecondaireFrancais = replace(trim(request("EtudesPostSecondaireFrancais")),"'","''")
EtudesCollegeFrancais = replace(trim(request ("EtudesCollegeFrancais")),"'","''")
EtudesMetierFrancais = replace(trim(request ("EtudesMetierFrancais")),"'","''")

institutionname1 = replace(trim(request("institutionname1")),"'","''")
institutiontype1 = replace(trim(request("institutiontype1")),"'","''")
diploma1 = replace(trim(request("diploma1")),"'","''")
institutiondatefrom1 = replace(trim(request("institutiondatefrom1")),"'","''")
institutiondateto1 = replace(trim(request("institutiondateto1")),"'","''")

institutionname2 = replace(trim(request("institutionname2")),"'","''")
institutiontype2 = replace(trim(request("institutiontype2")),"'","''")
diploma2 = replace(trim(request("diploma2")),"'","''")
institutiondatefrom2 = replace(trim(request("institutiondatefrom2")),"'","''")
institutiondateto2 = replace(trim(request("institutiondateto2")),"'","''")

institutionname3 = replace(trim(request("institutionname3")),"'","''")
institutiontype3 = replace(trim(request("institutiontype3")),"'","''")
diploma3 = replace(trim(request("diploma3")),"'","''")
institutiondatefrom3 = replace(trim(request("institutiondatefrom3")),"'","''")
institutiondateto3 = replace(trim(request("institutiondateto3")),"'","''")

NamePresentEmployer = replace(trim(request("NamePresentEmployer")),"'","''")
CityCountryPresentEmployer = replace(trim(request("CityCountryPresentEmployer")),"'","''")
PositionPresentEmployer = replace(trim(request("PositionPresentEmployer")),"'","''")
DateFromPresentEmployer = replace(trim(request("DateFromPresentEmployer")),"'","''")
DatetoPresentEmployer = replace(trim(request("DatetoPresentEmployer")),"'","''")
presentemployerduties = replace(trim(request("presentemployerduties")),"'","''")

NamepreviousEmployer = replace(trim(request("NamepreviousEmployer")),"'","''")
CityCountrypreviousEmployer = replace(trim(request("CityCountrypreviousEmployer")),"'","''")
PositionpreviousEmployer = replace(trim(request("PositionpreviousEmployer")),"'","''")
DateFrompreviousEmployer = replace(trim(request("DateFrompreviousEmployer")),"'","''")
DatetopreviousEmployer = replace(trim(request("DatetopreviousEmployer")),"'","''")
previousemployerduties = replace(trim(request("previousemployerduties")),"'","''")

NamepreviousEmployer2 = replace(trim(request("NamepreviousEmployer2")),"'","''")
CityCountrypreviousEmployer2 = replace(trim(request("CityCountrypreviousEmployer2")),"'","''")
PositionpreviousEmployer2 = replace(trim(request("PositionpreviousEmployer2")),"'","''")
DateFrompreviousEmployer2 = replace(trim(request("DateFrompreviousEmployer2")),"'","''")
DatetopreviousEmployer2 = replace(trim(request("DatetopreviousEmployer2")),"'","''")
previousemployerduties2 = replace(trim(request("previousemployerduties2")),"'","''")

'Conjoint
cjt = replace(trim(request("cjt")),"'","''")
cLastname = replace(trim(request("cLastname")),"'","''")
cFirstname = replace(trim(request("cFirstname")),"'","''")
cAge = replace(trim(request("cAge")),"'","''")
cForm = replace(trim(request("cForm")),"'","''")
cFormP = replace(trim(request("cFormP")),"'","''")
cExp = replace(trim(request("cExp")),"'","''")
exprFrCj = replace(trim(request("exprFrCj")),"'","''")
etFrCj = replace(trim(request("etFrCj")),"'","''")

%>


<html><head>
<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
<title>B&amp;A: Assessment Form for &quot;Skilled Worker&quot; Applicants</title>
<a name="#Top of page"></a>	
</head>

<body bgcolor="white"><center>
<table width="580" border="0" cellspacing="0" cellpadding="2">
  <tr><td width="442" valign="top" height="4876">
  	<center><font face="Verdana" size="+1">
	<b>Assessment Form for &quot;Skilled Worker&quot; Applicants</b></font></p></center>
	
      <ul><font face="Verdana" size="3">
	  If you would like to receive a free assessment of your qualifications as 
	  a skilled worker applicant for the purpose of Canadian 
	  immigration you are invited to complete the following assessment form.
      </p></font></ul>
	  
      <blockquote>
      <hr></blockquote>
      
	  <center><font face="Verdana" size="+2">
	  <b>General Information</b></font></p>
      </center>
	  
	  <form action="validation_work_en.asp" method="post">
      <blockquote>
	  <font face="Verdana" size="2">
	  <b>Last name:<br></b> 
      <input type="text" name="lastname" value="<%=Server.HTMLEncode(lastname)%>" size="30" tabindex="1">
	  <br>
      <b>First name:</b><br>
	  <input type="text" name="firstname" value="<%=Server.HTMLEncode(firstname)%>" size="30" tabindex="2">
	  <br>
      <b>Permanent Address:</b><br>
	  <textarea name="address" rows="6" cols="35" tabindex="3"><%=Server.HTMLEncode(address)%></textarea>
	  </p>
	  <b>E-mail:</b> 
      <input type="text" name="email" value="<%=Server.HTMLEncode(email)%>" size="30" tabindex="4"></p>
	  <p></p>
      <b>Age:</b>
	  <input type="text" name="age" value="<%=Server.HTMLEncode(age)%>" size="4" maxlength="2" tabindex="5">
      <b>Sex:</b>
	  Male <input type="radio" value="Male" name="sex" <% if request("sex")="Male" then response.write "checked=""checked""" end if %> tabindex="6">
      Female <input type="radio" value="Female" name="sex" <% if request("sex")="Female" then response.write "checked=""checked""" end if %>tabindex="7"></p>
      
	  <p></p>
	  <b>Marital Status: </b>
	  Single 
      <input type="radio" value="single" name="marital" <% if request("marital")="single" then response.write "checked=""checked""" end if %> true tabindex="8">
      Married 
	  <input type="radio" value="married" name="marital" <% if request("marital")="married" then response.write "checked=""checked""" end if %> tabindex="9"></p>
	  
	  <p></p>
	  <b>Number of children of 12 years or less:</b> 
      <input type="text" name="children" value="<%=Server.HTMLEncode(children)%>" size="5" maxlength="2" tabindex="10"></p>
	  
	  <p></p><b>
	  Family in Quebec:</b>
	  No
	  <b><input type="radio" value="Non" name="FamilleAuQuebec" <% if request("FamilleAuQuebec")="Non" then response.write "checked=""checked""" end if %> tabindex="11"></b>
	  Yes
	  <b><input type="radio" value="Oui" name="FamilleAuQuebec" <% if request("FamilleAuQuebec")="Oui" then response.write "checked=""checked""" end if %> tabindex="12"></b></p>
      
	  <p></p>
	  <b>Relationship to Closest relative in Quebec:<br></b> 
      <select name="ParentQuebec" value="<%=Server.HTMLEncode(ParentQuebec)%>" size="1" tabindex="13">
           	<option value="Aucune" <% if request("ParentQuebec")="Aucune" then response.write "selected" end if %>>None</option>
        	<option value="Conjoints" <% if request("ParentQuebec")="Conjoints" then response.write "selected" end if %>>Conjoints</option>
			<option value="Parents" <% if request("ParentQuebec")="Parents" then response.write "selected" end if %>>Parent</option>
            <option value="Grand Parents" <% if request("ParentQuebec")="Grand Parents" then response.write "selected" end if %>>Grand Parent</option>
            <option value="Enfants" <% if request("ParentQuebec")="Enfants" then response.write "selected" end if %>>Child</option>
            <option value="FrèreSoeur" <% if request("ParentQuebec")="FrèreSoeur" then response.write "selected" end if %>>Brother/Sister</option>
            <option value="Beau-frère/Belle-soeur" <% if request("ParentQuebec")="Beau-frère/Belle-soeur" then response.write "selected" end if %>>Brother/Sister-in-law</option>
            <option value="TanteOncle" <% if request("ParentQuebec")="TanteOncle" then response.write "selected" end if %>>Aunt/Uncle</option>
            <option value="NièceNeveu" <% if request("ParentQuebec")="NièceNeveu" then response.write "selected" end if %>>Nephew/Niece</option>
            <option value="Autre" <% if request("ParentQuebec")="Autre" then response.write "selected" end if %>>Other</option>
       </select></p>
	  
	  <p></p>
	  <b>Family in Canada:</b> 
		No <input type="radio" value="no" name="FamilyInCanada" <% if request("FamilyInCanada")="no" then response.write "checked=""checked""" end if %> tabindex="14" true>
        Yes <input type="radio" value="yes" name="FamilyInCanada" <% if request("FamilyInCanada")="yes" then response.write "checked=""checked""" end if %> tabindex="15"></p>
        
	<p></p>
	<b>Relationship to Closest relative in Canada:<br></b> 
    	<select name="ParentsCanada" value="<%=Server.HTMLEncode(ParentsCanada)%>" size="1" tabindex="16">
            <option value="Aucune" <% if request("ParentsCanada")="Aucune" then response.write "selected" end if %>>None</option>
			<option value="Parents" <% if request("ParentsCanada")="Parents" then response.write "selected" end if %>>Parent</option>
            <option value="Grand Parents" <% if request("ParentsCanada")="Grand Parents" then response.write "selected" end if %>>Grand Parent</option>
            <option value="Enfants" <% if request("ParentsCanada")="Enfants" then response.write "selected" end if %>>Child</option>
            <option value="FrèreSoeur" <% if request("ParentsCanada")="FrèreSoeur" then response.write "selected" end if %>>Brother/Sister</option>
            <option value="Beau-frère/Belle-soeur" <% if request("ParentsCanada")="Beau-frère/Belle-soeur" then response.write "selected" end if %>>Brother/Sister-in-law</option>
            <option value="TanteOncle" <% if request("ParentsCanada")="TanteOncle" then response.write "selected" end if %>>Aunt/Uncle</option>
            <option value="NièceNeveu" <% if request("ParentsCanada")="NièceNeveu" then response.write "selected" end if %>>Nephew/Niece</option>
            <option value="Autre" <% if request("ParentsCanada")="Autre" then response.write "selected" end if %>>Other</option>

          </select></p>
	
	<p></p>
	<b>Friends in Quebec:</b>
	No
	<b><input type="radio" value="Non" name="AmisAuQuebec" <% if request("AmisAuQuebec")="Non" then response.write "checked=""checked""" end if %> tabindex="17"></b>
	Yes
	<b><input type="radio" value="Oui" name="AmisAuQuebec" <% if request("AmisAuQuebec")="Oui" then response.write "checked=""checked""" end if %> tabindex="18"></b></p>

	<p></p>
        <b>Stay in Quebec ?</b><br>
        <select name="sejourQc" value="<%=Server.HTMLEncode(sejourQc)%>" size="1" tabindex="19">
          <option value="choose" <% if request("sejourQc")="choose" then response.write "selected" end if %>>Choose 1 option</option>
          <option value="0" <% if request("sejourQc")="0" then response.write "selected" end if %>>No stay</option>
          <option value="1" <% if request("sejourQc")="1" then response.write "selected" end if %>>School one session</option>
          <option value="2" <% if request("sejourQc")="2" then response.write "selected" end if %>>School two sessions or +</option>
          <option value="3" <% if request("sejourQc")="3" then response.write "selected" end if %>>Job 3 months</option>
          <option value="4" <% if request("sejourQc")="4" then response.write "selected" end if %>>Job 6 months or +</option>
          <option value="5" <% if request("sejourQc")="5" then response.write "selected" end if %>>Internship 3 months</option>
          <option value="6" <% if request("sejourQc")="6" then response.write "selected" end if %>>Internship 6 months or +</option>
          <option value="7" <% if request("sejourQc")="7" then response.write "selected" end if %>>Stay from 2 weeks to 3 months</option>
          <option value="8" <% if request("sejourQc")="8" then response.write "selected" end if %>>Stay over 3 months</option>
        </select>  
     </p>
	
	<p></p>
	<b>Have you ever been to Canada</b><br>
    No
    <input type="radio" value="no" name="BeenToCanada" <% if request("BeenToCanada")="no" then response.write "checked=""checked""" end if %> tabindex="19" true>
    Yes 
    <input type="radio" value="yes" name="BeenToCanada" <% if request("BeenToCanada")="yes" then response.write "checked=""checked""" end if %> tabindex="20">
    <br><br>
    <b>If so, please specify the places and dates:</b><br>
    <textarea name="placesdates" rows="5" cols="35" tabindex="21"><%=Server.HTMLEncode(placesdates)%></textarea></p>
	 
	<p></p>
	<b>In what capacity did you come to Canada ?</b><br>
    Tourist
    <input type="checkbox" name="ReasonVisitCanada" value="Tourist" <% if request("ReasonVisitCanada")="Tourist" then response.write "checked=""checked""" end if %> tabindex="22">
    Worker
    <input type="checkbox" name="ReasonVisitCanada" value="Worker" <% if request("ReasonVisitCanada")="Worker" then response.write "checked=""checked""" end if %> tabindex="23">
    Student
    <input type="checkbox" name="ReasonVisitCanada" value="student" <% if request("ReasonVisitCanada")="student" then response.write "checked=""checked""" end if %> tabindex="24">
    </p>
    <p></p>
	<hr>
	</p>
	<center>
	<p></p><b>Language Abilities</b></p>
	</blockquote></center>
    <center>
	<p></p>
	<b>English<br></b></p></center>
    
	<center><p></p>
    <table width="100%" border="1" cellspacing="1" cellpadding="3">
    <tr height="25" align="center" valign="middle">
		<td width="15%" height="25" align="center" valign="middle" bgcolor="#ff9900">
			<font face="Verdana" size="2">
			Speak</font>
		</td>
        <td align="center" height="25" valign="middle">
			
			<font face="Verdana" size="2">
			Fluently 
            <input type="radio" value="courant" name="speakenglish" <% if request("speakenglish")="courant" then response.write "checked=""checked""" end if %> tabindex="25">
            Well 
            <input type="radio" value="bien" name="speakenglish" <% if request("speakenglish")="bien" then response.write "checked=""checked""" end if %> tabindex="26">
            With Difficulty 
            <input type="radio" value="peu" name="speakenglish" <% if request("speakenglish")="peu" then response.write "checked=""checked""" end if %> tabindex="27">
            Not at all 
            <input type="radio" value="non" name="speakenglish" <% if request("speakenglish")="non" then response.write "checked=""checked""" end if %> tabindex="28" true>
            </font>
		</td>
	</tr>
	<tr height="21"> 
		<td height="21" align="center" width="15%" bgcolor="#ff9900">
			<font face="Verdana" size="2">
			Read</font>
		</td>
            <td align="center" height="21"><font face="Verdana" size="2">Fluently
              <input type="radio" value="courant" name="readenglish" <% if request("readenglish")="courant" then response.write "checked=""checked""" end if %> tabindex="29">
              Well
              <input type="radio" value="bien" name="readenglish" <% if request("readenglish")="bien" then response.write "checked=""checked""" end if %> tabindex="30">
              With Difficulty
              <input type="radio" value="peu" name="readenglish" <% if request("readenglish")="peu" then response.write "checked=""checked""" end if %> tabindex="31">
              Not at all
              <input type="radio" value="non" name="readenglish" true <% if request("readenglish")="non" then response.write "checked=""checked""" end if %> tabindex="32">
              </font></td>
	</tr>
	<tr height="21"> 
		<td height="21" align="center" width="15%" bgcolor="#ff9900">
			
			<font face="Verdana" size="2">Write</font>
		</td>
        <td align="center" height="21" valign="middle">
			
			<font face="Verdana" size="2">
			Fluently 
              <input type="radio" value="courant" name="writeenglish" <% if request("writeenglish")="courant" then response.write "checked=""checked""" end if %> tabindex="33">
            Well 
              <input type="radio" value="bien" name="writeenglish" <% if request("writeenglish")="bien" then response.write "checked=""checked""" end if %> tabindex="34">
            With Difficulty 
              <input type="radio" value="peu" name="writeenglish" <% if request("writeenglish")="peu" then response.write "checked=""checked""" end if %> tabindex="35">
            Not at all 
              <input type="radio" value="non" name="writeenglish" <% if request("writeenglish")="non" then response.write "checked=""checked""" end if %> tabindex="36" true>
            </font>
		</td>
	</tr>
    </table></center> 
        
	<center>
	<p></p><font face="Verdana" size="2">
	<b>French<br></b></p></font>
    </center>
    
	<center>
    <p></p> 
       
        <table width="100%" border="1" cellspacing="1" cellpadding="3">
          <tr height="28"> 
            <td width="15%" height="28" align="center" bgcolor="#ff9900">
			
			<font face="Verdana" size="2">Speak</font></td>
            <td colspan="2" align="center" height="28">
			
			<font face="Verdana" size="2">Fluently 
              <input type="radio" value="courant" name="speakfrench" <% if request("speakfrench")="courant" then response.write "checked=""checked""" end if %> tabindex="37">
              Well 
              <input type="radio" value="bien" name="speakfrench" <% if request("speakfrench")="bien" then response.write "checked=""checked""" end if %> tabindex="38">
              With Difficulty
              <input type="radio" value="peu" name="speakfrench" <% if request("speakfrench")="peu" then response.write "checked=""checked""" end if %> tabindex="39">
              Not at all
              <input type="radio" value="non" name="speakfrench" <% if request("speakfrench")="non" then response.write "checked=""checked""" end if %> tabindex="40" true>
              </font></td>
          </tr>
          <tr height="21"> 
            <td height="21" align="center" width="15%" bgcolor="#ff9900">
			
			<font face="Verdana" size="2">Read</font></td>
            <td colspan="2" align="center" height="21">
			
			<font face="Verdana" size="2">Fluently 
              <input type="radio" value="courant" name="readfrench" <% if request("readfrench")="courant" then response.write "checked=""checked""" end if %> tabindex="41">
              Well 
              <input type="radio" value="bien" name="readfrench" <% if request("readfrench")="bien" then response.write "checked=""checked""" end if %> tabindex="42">
              With Difficulty 
              <input type="radio" value="peu" name="readfrench" <% if request("readfrench")="peu" then response.write "checked=""checked""" end if %> tabindex="43">
              Not at all 
              <input type="radio" value="non" name="readfrench" <% if request("readfrench")="non" then response.write "checked=""checked""" end if %> tabindex="44" true>
              </font></td>
          </tr>
          <tr height="21"> 
            <td height="21" align="center" width="15%" bgcolor="#ff9900">
			
			<font face="Verdana" size="2">Write</font></td>
            <td colspan="2" align="center" height="21">
			
			<font face="Verdana" size="2">Fluently 
              <input type="radio" value="courant" name="writefrench" <% if request("writefrench")="courant" then response.write "checked=""checked""" end if %> tabindex="45">
              Well 
              <input type="radio" value="bien" name="writefrench" <% if request("writefrench")="bien" then response.write "checked=""checked""" end if %> tabindex="46">
              With Difficulty 
              <input type="radio" value="peu" name="writefrench" <% if request("writefrench")="peu" then response.write "checked=""checked""" end if %> tabindex="47">
              Not at all 
              <input type="radio" value="non" name="writefrench" <% if request("writefrench")="non" then response.write "checked=""checked""" end if %> tabindex="48" true>
              </font></td>
          </tr>
        </table>
        
      </center>
      <blockquote> 
        <p></p>
        
        <hr>
        
        <p></p><b>
		Education</b></center></p>
      </blockquote>
	  
	  <center>
        <p></p>
       
        <table width="100%" border="1" cellspacing="2" cellpadding="3">
          <tr height="17"> 
            <td width="33%" height="17" align="center" valign="middle">&nbsp;</td>
            <td width="33%" align="center" height="17"  valign="middle"> <font face="Verdana" size="2">
              <p></p><b><center>Number of years</center></b>
            </td>
            <td width="34%" align="center" height="17" valign="middle"> <font face="Verdana" size="2">
              <p></p><b>Language</b>
            </td>
          </tr>
          <tr height="28"> 
            <td width="33%" height="28" align="center"  valign="middle"> <font face="Verdana" size="2">
              <p></p>Elementary</font>
			  
            </td>
            <td width="65" align="center" height="28"  valign="middle"><center>&nbsp; <font face="Verdana" size="2">
			<select name="elementaryyears" value="<%=Server.HTMLEncode(elementaryyears)%>" size="1" tabindex="49">
	            <option value="0" <% if request("elementaryyears")="0" then response.write "selected" end if %>>0</option>
	            <option value="1" <% if request("elementaryyears")="1" then response.write "selected" end if %>>1</option>
	            <option value="2" <% if request("elementaryyears")="2" then response.write "selected" end if %>>2</option>
	            <option value="3" <% if request("elementaryyears")="3" then response.write "selected" end if %>>3</option>
	            <option value="4" <% if request("elementaryyears")="4" then response.write "selected" end if %>>4</option>
	            <option value="5" <% if request("elementaryyears")="5" then response.write "selected" end if %>>5</option>
          </select></center></font>
            </td>
            <td width="34%" align="center" height="28"  valign="middle"> <font face="Verdana" size="2">
              <p></p>French: 
                Yes&nbsp; 
                <input type="radio" value="oui" name="EtudesElementaireFrancais" <% if request("EtudesElementaireFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="50">
                No&nbsp; 
                <input type="radio" value="non" name="EtudesElementaireFrancais" <% if request("EtudesElementaireFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="51">
                </font>
            </td>
          </tr>
          <tr height="28"> 
            <td height="28" align="center" width="33%"> <font face="Verdana" size="2">
              <p></p>Secondary</font>
            </td>
            <td align="center" width="65" height="28">&nbsp; <font face="Verdana" size="2">
		 <select name="secondaryyears" value="<%=Server.HTMLEncode(secondaryyears)%>" size="1" tabindex="52">
	            <option value="0" <% if request("secondaryyears")="0" then response.write "selected" end if %>>0</option>
	            <option value="1" <% if request("secondaryyears")="1" then response.write "selected" end if %>>1</option>
	            <option value="2" <% if request("secondaryyears")="2" then response.write "selected" end if %>>2</option>
	            <option value="3" <% if request("secondaryyears")="3" then response.write "selected" end if %>>3</option>
	            <option value="4" <% if request("secondaryyears")="4" then response.write "selected" end if %>>4</option>
	            <option value="5" <% if request("secondaryyears")="5" then response.write "selected" end if %>>5</option>
          </select></font>
            </td>
            <td align="center" width="34%" height="28"> <font face="Verdana" size="2">
              <p></p>French: 
                Yes&nbsp; 
                <input type="radio" value="oui" name="EtudesSecondaireFrancais" <% if request("EtudesSecondaireFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="53">
                No&nbsp; 
                <input type="radio" value="non" name="EtudesSecondaireFrancais" <% if request("EtudesSecondaireFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="54">
                &nbsp;</font>
            </td>
          </tr>
          <tr height="28"> 
            <td height="28" align="center" width="33%"> <font face="Verdana" size="2">
              <p></p>Post Secondaire </font>
            </td>
            <td align="center" width="65" height="28">&nbsp; <font face="Verdana" size="2">
		 <select name="postsecondaryyears" value="<%=Server.HTMLEncode(postsecondaryyears)%>" size="1" tabindex="52">
	            <option value="0" <% if request("postsecondaryyears")="0" then response.write "selected" end if %>>0</option>
	            <option value="1" <% if request("postsecondaryyears")="1" then response.write "selected" end if %>>1</option>
	            <option value="2" <% if request("postsecondaryyears")="2" then response.write "selected" end if %>>2</option>
	            <option value="3" <% if request("postsecondaryyears")="3" then response.write "selected" end if %>>3</option>
          </select></font>
		  </td>
            <td align="center" width="34%" height="28"> <font face="Verdana" size="2">
              <p></p>French: 
                yes&nbsp; 
                <input type="radio" value="oui" name="EtudesPostSecondaireFrancais" <% if request("EtudesPostSecondaireFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="53">
                no&nbsp; 
                <input type="radio" value="non" name="EtudesPostSecondaireFrancais" <% if request("EtudesPostSecondaireFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="54">
                &nbsp;</font>
            </td></tr>
          <tr height="0"> 
            <td height="0" align="center" width="33%"> <font face="Verdana" size="2">
              <p></p>&nbsp;College/University</font>
            </td>
            <td height="0" align="center" width="65">&nbsp; <font face="Verdana" size="2">
		 <select name="collegeyears" value="<%=Server.HTMLEncode(collegeyears)%>" size="1" tabindex="55">
	            <option value="0" <% if request("collegeyears")="0" then response.write "selected" end if %>>None</option>
	            <option value="1" <% if request("collegeyears")="1" then response.write "selected" end if %>>University 1st cycle 1 year</option>
				<option value="2" <% if request("collegeyears")="2" then response.write "selected" end if %>>University 1st cycle 2 years</option>
	            <option value="3" <% if request("collegeyears")="3" then response.write "selected" end if %>>University 1st cycle 3 years</option>
	            <option value="4" <% if request("collegeyears")="4" then response.write "selected" end if %>>University 1st cycle 4 years and over</option>
 	            <option value="5" <% if request("collegeyears")="5" then response.write "selected" end if %>>University 2nd cycle</option>
	            <option value="6" <% if request("collegeyears")="6" then response.write "selected" end if %>>University 3nd cycle</option>
          </select></font>
            </td>
            <td height="0" align="center" width="34%"> <font face="Verdana" size="2">
              <p></p>French: 
                Yes&nbsp; 
                <input type="radio" value="oui" name="EtudesCollegeFrancais" <% if request("EtudesCollegeFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="56">
                No&nbsp; 
                <input type="radio" value="non" name="EtudesCollegeFrancais" <% if request("EtudesCollegeFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="57">
                &nbsp;</font>
            </td>
          </tr>
		 <tr height="28"> 
            <td height="28" align="center" width="33%"> <font face="Verdana" size="2">
              <p></p>Private Training</font>
            </td>
            <td align="center" width="65" height="28">&nbsp; <font face="Verdana" size="2">
		 <select name="privateTraining" value="<%=Server.HTMLEncode(privateTraining)%>" size="1" tabindex="52">
	            <option value="0" <% if request("privateTraining")="0" then response.write "selected" end if %>>None</option>
	            <option value="1" <% if request("privateTraining")="1" then response.write "selected" end if %>>University</option>
	            <option value="2" <% if request("privateTraining")="2" then response.write "selected" end if %>>Other</option>
          </select></font>
		  </td>
            <td align="center" width="34%" height="28"> <font face="Verdana" size="2">
              <p></p>French: 
                yes&nbsp; 
                <input type="radio" value="oui" name="privateTrainingFrancais" <% if request("privateTrainingFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="53">
                no&nbsp; 
                <input type="radio" value="non" name="privateTrainingFrancais" <% if request("privateTrainingFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="54">
                &nbsp;</font>
            </td></tr>
			
			
          <tr height="28"> 
            <td height="28" align="center" width="33%"> <font face="Verdana" size="2">
              <p class="bodytext">Second Technical Training</font>
            </td>
            <td align="center" width="65" height="28">&nbsp; <font face="Verdana" size="2">
		 <select name="secondSpec" value="<%=Server.HTMLEncode(secondSpec)%>" size="1" tabindex="52">
	            <option value="0" <% if request("secondSpec")="0" then response.write "selected" end if %>>0</option>
	            <option value="1" <% if request("secondSpec")="1" then response.write "selected" end if %>>1</option>
	            <option value="2" <% if request("secondSpec")="2" then response.write "selected" end if %>>2</option>
          </select></font>
		  </td>
            <td align="center" width="34%" height="28"> <font face="Verdana" size="2">
              <p></p>French: 
                yes&nbsp; 
                <input type="radio" value="oui" name="EtudesSecondSpecFrancais" <% if request("EtudesSecondSpecFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="53">
                no&nbsp; 
                <input type="radio" value="non" name="EtudesSecondSpecFrancais" <% if request("EtudesSecondSpecFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="54">
                &nbsp;</font>
            </td></tr>
			
			
          <tr height="17"> 
            <td height="17" align="center" width="33%"> <font face="Verdana" size="2">
              <p></p>Vocational or Technical Training</font>
            </td>
            <td align="center" width="65" height="17">&nbsp; <font face="Verdana" size="2">
		 <select name="vocationalyears" value="<%=Server.HTMLEncode(vocationalyears)%>" size="1" tabindex="58">
	            <option value="0" <% if request("vocationalyears")="0" then response.write "selected" end if %>>0</option>
	            <option value="1" <% if request("vocationalyears")="1" then response.write "selected" end if %>>1</option>
	            <option value="2" <% if request("vocationalyears")="2" then response.write "selected" end if %>>2</option>
          </select></font>
            </td>
            <td align="center" width="34%" height="17"> <font face="Verdana" size="2">
              <p>&nbsp;French: 
                Yes&nbsp; 
                <input type="radio" value="oui" name="EtudesMetierFrancais" <% if request("EtudesMetierFrancais")="oui" then response.write "checked=""checked""" end if %> tabindex="59">
                No&nbsp; 
                <input type="radio" value="non" name="EtudesMetierFrancais" <% if request("EtudesMetierFrancais")="non" then response.write "checked=""checked""" end if %> tabindex="60">
                &nbsp;</font>
            </td>
          </tr>
        </table>
       
      </center>
      <blockquote> <font face="Verdana" size="2">
        <p></p><b>Highest level of schooling obtained:</b><br>
          <input type="text" name="highestschoollevel" value="<%=Server.HTMLEncode(highestschoollevel)%>" size="35" maxlength="35" tabindex="61">
         </p>
        <center>
          <p></p><b>Detailed Information on Education Since<br>
             Elementary School</b></p>
        </center>
        <p></p><b>Name of Institution #1<br>
          </b> 
          <input type="text" name="institutionname1" value="<%=Server.HTMLEncode(institutionname1)%>" size="30" maxlength="50" tabindex="62">
          <br>
          <b>Type of Institution<br>
          </b> 
          <input type="text" name="institutiontype1" value="<%=Server.HTMLEncode(institutiontype1)%>" size="30" maxlength="50" tabindex="63">
          <br>
          <b>Diploma or Certificate Obtained<br>
          </b> 
          <input type="text" name="diploma1" value="<%=Server.HTMLEncode(diploma1)%>" size="37" maxlength="30" tabindex="64">
          <br>
          <b>Dates<br>
          </b></p>
        <p></p>
        <table width="300" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="50%" align="center"> <font face="Verdana" size="2">
             <b>From (Year/month)<br>
                </b>
                <input type="text" name="institutiondatefrom1" value="<%=Server.HTMLEncode(institutiondatefrom1)%>" size="18" maxlength="7" tabindex="65">
                
            </td>
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p>&nbsp;&nbsp;<b>To (Year/month)<br>
                </b> 
                <input type="text" name="institutiondateto1" value="<%=Server.HTMLEncode(institutiondateto1)%>" size="18" maxlength="7" tabindex="66">
                
            </td>
          </tr>
        </table>
        
        <center>
          <p></p>
		  <blockquote> 
		  **********************</p>
		  </blockquote>
        </center>
        <p></p><b>Name of Institution #2<br>
          </b> 
          <input type="text" name="institutionname2" value="<%=Server.HTMLEncode(institutionname2)%>" size="30" maxlength="50" tabindex="67">
          <br>
          <b>Type of Institution<br>
          </b> 
          <input type="text" name="institutiontype2" value="<%=Server.HTMLEncode(institutiontype2)%>" size="30" maxlength="50" tabindex="68">
          <br>
          <b>Diploma or Certificate Obtained<br>
          </b> 
          <input type="text" name="diploma2" value="<%=Server.HTMLEncode(diploma2)%>" size="37" maxlength="30" tabindex="69">
          <br>
          <b>Dates<br>
          </b></p>
        <p></p> 
        <table width="300" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>From (Year/month)<br>
                </b>
                <input type="text" name="institutiondatefrom2" value="<%=Server.HTMLEncode(institutiondatefrom2)%>" size="18" maxlength="7"  tabindex="70">
                
            </td>
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p>&nbsp;&nbsp;<b>To (Year/month)<br>
                </b> 
                <input type="text" name="institutiondateto2" value="<%=Server.HTMLEncode(institutiondateto2)%>" size="18" maxlength="7" tabindex="71">
               
            </td>
          </tr>
        </table>
      
        <center>
          <p></p>**********************</p>
        </center>
        <p></p><b>Name of Institution #3<br>
          </b> 
          <input type="text" name="institutionname3" value="<%=Server.HTMLEncode(institutionname3)%>" size="30" maxlength="50" tabindex="72">
          <br>
          <b>Type of Institution<br>
          </b> 
          <input type="text" name="institutiontype3" value="<%=Server.HTMLEncode(institutiontype3)%>" size="30" maxlength="50" tabindex="73">
          <br>
          <b>Diploma or Certificate Obtained<br>
          </b> 
          <input type="text" name="diploma3" value="<%=Server.HTMLEncode(diploma3)%>" size="37" maxlength="30" tabindex="74">
          <br>
          <b>Dates<br>
          </b></p>
        <p></p>
        <table width="300" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>From (Year/month)<br>
                </b>
                <input type="text" name="institutiondatefrom3" value="<%=Server.HTMLEncode(institutiondatefrom3)%>" size="18" maxlength="7" tabindex="75">
               
            </td>
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p>&nbsp;<b>To (Year/month)<br>
                </b> 
                <input type="text" name="institutiondateto3" value="<%=Server.HTMLEncode(institutiondateto3)%>" size="18" maxlength="7" tabindex="76">
                
            </td>
          </tr>
        </table>
       </p>
		<p></p>
		<hr></p>
        <center><font face="Verdana" size="2">
          <p></p><b>Work History</b></p>
        </center>
        <center>
          <p></p><b>Present Occupation</b></p>
        </center>
        <p></p><b>Name of Employer<br>
          </b> 
          <input type="text" name="NamePresentEmployer" value="<%=Server.HTMLEncode(NamePresentEmployer)%>" size="30" maxlength="50" tabindex="77">
          <br>
          <b>City and Country<br>
          </b> 
          <input type="text" name="CityCountryPresentEmployer" value="<%=Server.HTMLEncode(CityCountryPresentEmployer)%>" size="30" maxlength="50" tabindex="78">
          <br>
          <b>Position<br>
          </b> 
          <input type="text" name="PositionPresentEmployer" value="<%=Server.HTMLEncode(PositionPresentEmployer)%>" size="30" maxlength="50" tabindex="79">
          <br>
          <b>Dates<br>
          </b></p>
        <p></p>
        <table width="300" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>From (Year/month)<br>
                </b>
                <input type="text" name="DateFromPresentEmployer" value="<%=Server.HTMLEncode(DateFromPresentEmployer)%>" size="18" maxlength="7" tabindex="80">
                
            </td>
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p>&nbsp;&nbsp;&nbsp;<b>To (Year/month)<br>
                </b> 
                <input type="text" name="DatetoPresentEmployer" value="<%=Server.HTMLEncode(DatetoPresentEmployer)%>" size="18" maxlength="7" tabindex="81">
               
            </td>
          </tr>
        </table>
       
        <p></p><b>Duties </b>: 
          (Please provide a one paragraph description of your duties which mentions the most important 
		  aspects of your work experience in this designation):<br>
          
          <textarea name="presentemployerduties" rows="6" cols="30" tabindex="82"><%=Server.HTMLEncode(presentemployerduties)%></textarea>
          </p>
      </blockquote>
      <center>
        <p></p>***********************</p>
      </center>
      <blockquote> 
        <p></p><b>Previous Occupation #1</b></p>
        <p></p><b>Name of Employer<br>
          </b> 
          <input type="text" name="NamepreviousEmployer" value="<%=Server.HTMLEncode(NamepreviousEmployer)%>" size="30" maxlength="50" tabindex="83">
          <br>
          <b>City and Country<br>
          </b> 
          <input type="text" name="CityCountrypreviousEmployer" value="<%=Server.HTMLEncode(CityCountrypreviousEmployer)%>" size="30" maxlength="50" tabindex="84">
          <br>
          <b>Position<br>
          </b> 
          <input type="text" name="PositionpreviousEmployer" value="<%=Server.HTMLEncode(PositionpreviousEmployer)%>" size="30" maxlength="50" tabindex="85">
          <br>
          <b>Dates<br>
          </b></p>
        <p></p>
        <table width="300" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>From (Year/month)<br>
                </b>
                <input type="text" name="DateFrompreviousEmployer" value="<%=Server.HTMLEncode(DateFrompreviousEmployer)%>" size="18" maxlength="7" tabindex="86">
               
            </td>
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>To (Year/month)<br>
                </b>
                <input type="text" name="DatetopreviousEmployer" value="<%=Server.HTMLEncode(DatetopreviousEmployer)%>" size="18" maxlength="7" tabindex="87">
                
            </td>
          </tr>
        </table>
       
        <p></p><b>Duties</b>: 
          (Please provide a one paragraph description of your duties which mentions the most important 
		  aspects of your work experience in this designation):<br>
          
          <textarea name="previousemployerduties" rows="6" cols="30" tabindex="88"><%=Server.HTMLEncode(previousemployerduties)%></textarea>
          </p>
      </blockquote>
      <p></p><center>***********************</center></p>
      <blockquote> 
        <p></p><b>Previous Occupation #2</b></p>
        <p></p><b>Name of Employer<br>
          </b> 
          <input type="text" name="NamepreviousEmployer2" value="<%=Server.HTMLEncode(NamepreviousEmployer2)%>" size="30" maxlength="30" tabindex="89">
          <br>
          <b>City and Country<br>
          </b> 
          <input type="text" name="CityCountrypreviousEmployer2" value="<%=Server.HTMLEncode(CityCountrypreviousEmployer2)%>" size="30" maxlength="50" tabindex="90">
          <br>
          <b>Position<br>
          </b> 
          <input type="text" name="PositionpreviousEmployer2" value="<%=Server.HTMLEncode(PositionpreviousEmployer2)%>" size="30" maxlength="50" tabindex="91">
          <br>
          <b>Dates<br>
          </b></p>
        <p></p>
        <table width="300" border="0" cellspacing="0" cellpadding="0">
          <tr> 
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>From (Year/month)<br>
                </b> 
                <input type="text" name="DateFrompreviousEmployer2" value="<%=Server.HTMLEncode(DateFrompreviousEmployer2)%>" size="18" maxlength="7" tabindex="92">
                
            </td>
            <td width="50%" align="center"> <font face="Verdana" size="2">
              <p></p><b>To (Year/month)<br>
                </b>
                <input type="text" name="DatetopreviousEmployer2" value="<%=Server.HTMLEncode(DatetopreviousEmployer2)%>" size="18" maxlength="7" tabindex="93">
             
            </td>
          </tr>
        </table>
       
        <p></p><b>Duties</b>: 
          (Please provide a one paragraph description of your duties which mentions the most important 
		  aspects of your work experience in this designation):<b><br>
          </b> 
          <textarea name="previousemployerduties2" rows="6" cols="30" tabindex="94"><%=Server.HTMLEncode(previousemployerduties2)%></textarea>
         </p>
      </blockquote>
      <center>
        <p></p><center>***********************</center><br>
          </p>
      </center>
	  
	   <blockquote> 
        <p></p>
		<b>Do you have a spouse ?</b><br><br>
		yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<input type="radio" value="oui" name="cjt" <% if request("cjt")="oui" then response.write "checked=""checked""" end if %>><br>
		no&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<input type="radio" value="non" name="cjt" <% if request("cjt")="non" then response.write "checked=""checked""" end if %>><br><br>
	     
		 <b>Name:<br>
          </b> 
          <input type="text" name="cLastname" value="<%=Server.HTMLEncode(cLastname)%>" size="30"><br><br>
          
		  <b>Firstname:</b><br>
          <input type="text" name="cFirstname" value="<%=Server.HTMLEncode(cFirstname)%>" size="30"><br><br>
		 
		 <b>Age:</b><br>
          <select name="cAge" value="<%=Server.HTMLEncode(cAge)%>" size="1">
		  	    <option value="choose" <% if request("cAge")= "choose" then response.write "selected" end if %>>Choose</option>
	            <option value="19 et -" <% if request("cAge")="19 et -" then response.write "selected" end if %>>less than 19 years old</option>
	            <option value="20 a 39" <% if request("cAge")="20 a 39" then response.write "selected" end if %>>20 to 39 years old</option>
				<option value="40 a 45" <% if request("cAge")="40 a 45" then response.write "selected" end if %>>40 to 45 years old</option>
	            <option value="46 et +" <% if request("cAge")="46 et +" then response.write "selected" end if %>>over 46 years old</option>
          </select><br><br><br>
	 	  
		 <b>Professional experience:</b><br>
          <select name="cExp" value="<%=Server.HTMLEncode(cExp)%>" size="1" tabindex="58">
		  		<option value="choose" <% if request("cExp")= "choose" then response.write "selected" end if %>>choose</option>
	            <option value="0" <% if request("cExp")="0" then response.write "selected" end if %>>0</option>
	            <option value="1" <% if request("cExp")="1" then response.write "selected" end if %>>1 to 6 months</option>
	            <option value="2" <% if request("cExp")="2" then response.write "selected" end if %>>1 year and over</option>
          </select><br><br>
		  
		 <b>Education:</b><br><br>
          <select name="cForm" value="<%=Server.HTMLEncode(cForm)%>" size="1">
		  	    <option value= "choose" <% if request("cForm")= "choose" then response.write "selected" end if %>>Choose</option>
	            <option value="0" <% if request("cForm")= "0" then response.write "selected" end if %>>None</option>
				<option value="1" <% if request("cForm")= "1" then response.write "selected" end if %>>Secondary</option>
	            <option value="2" <% if request("cForm")= "2" then response.write "selected" end if %>>Postsecondary 1 year</option>
	            <option value="3" <% if request("cForm")= "3" then response.write "selected" end if %>>University 3 years</option>
          </select><br><br><br>
		  
		<b>Other vocational education:</b><br><br>
		  <select name="cFormP" value="<%=Server.HTMLEncode(cFormP)%>" size="1">
		  	    <option value="choose" <% if request("cFormP")="choose" then response.write "selected" end if %>>Choose</option>
	            <option value="0" <% if request("cFormP")="0" then response.write "selected" end if %>>None</option>
				<option value="1" <% if request("cFormP")="1" then response.write "selected" end if %>>2nd vocational education or private school</option>
          </select><br><br>
		  
	  	<br><b>French language:</b><br><br>
		Speaking and reading<br>
        Good&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<input type="radio" value="oui" name="expFrCj" <% if request("expFrCj")="oui" then response.write "checked=""checked""" end if %>>
	    <br>With difficulty&nbsp;&nbsp;
		<input type="radio" value="non" name="expFrCj" <% if request("expFrCj")="non" then response.write "checked=""checked""" end if %>>  
	  <br><br>
	  	<b>Secondary or Postsecondary school in French:</b><br><br>
	    yes&nbsp;&nbsp;&nbsp;
		<input type="radio" value="oui" name="etFrCj" <% if request("etFrCj")="oui" then response.write "checked=""checked""" end if %>><br>
	    no&nbsp;&nbsp;&nbsp;
		<input type="radio" value="non" name="etFrCj" <% if request("etFrCj")="non" then response.write "checked=""checked""" end if %>>  
		</p>
	  
	    <center>
           *********************** 
        </center>
	  
	  
	  </blockquote> 
	  
	  
      <p></p>
      <table width="100%" border="0" cellspacing="2" cellpadding="0">
        <tr> 
          <td width="100%" align="center" valign="top">&nbsp;
            <input type="submit" name="Submit" value="Submit">
            <input type="reset" name="name" value="Reset">
            </td>
        </tr>
      </table>
     
      <center>
        <blockquote> 
          <p><b>Please make sure that the address you provided is correct.</b></p> 
            <br>
            <br>
            <a href="#Top of page"> Back to top of this page</b></a> </p>
        </blockquote>
      </center>
    </td>
  </tr>
  <tr> 
    <td colspan="2"> 
      <hr>
    </td>
  </tr>
  <tr height="47"> 
    <td height="47" width="442">
	<center>
	<p></p>&copy;2002 
      Bench&eacute;trit &amp; Associates. All rights reserved.<br>
     Last updated on: May 2002
  </tr></table></center>
<p></form>
</body></html>