Affiliate Application Form

FSEAP Affiliate Application Submission

Do you want to work with us? Please fill in your details below.
Thank you for your interest in joining our affiliate provider network.

Before beginning your application to join our Employee Assistance Program (EAP) provider network, we ask that you review the eligibility requirements outlined on the following page. FSEAP adheres to credentialing standards established by relevant legislation and regulatory bodies in each province. In certain unregulated regions or remote areas, there may be flexibility in the criteria to help meet service demands.

Your application will be evaluated based on the information you provide. If you do not fully meet the eligibility criteria, please ensure your resume or CV clearly reflects your education, experience, and relevant skill set to support your application.

The application process typically takes up to 10 minutes and requires the submission of supporting documents. You may save your progress and return to complete your application at a later time, if needed.

For questions regarding eligibility or application criteria, please contact us at careers@fseap.ca .

Affiliate Recruitment Process

1. Your application and supporting documents will be reviewed by our Affiliate Manager. You may be contacted for additional information if necessary.

2. If your application is successful, a criminal background check will be required.

3. Once all documentation is received and approved, a formal agreement will be issued for signature.

4. Upon completion of the contracting process, onboarding information will be provided to integrate you into our affiliate network.

Virtual Practice Information

Virtual Practice Hours*

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Office Hours

Which secure virtual platform(s) do you use for the provision of services? *
Is there anything specific we should know about how your therapy locations and appointment scheduling are structured to balance virtual and in person work? *

Competencies and Training
How many years’ (or hours) experience do you have providing counselling or services through an EAP provider?*
How many years’ of experience do you have providing short-term, solution focused counselling? *
How many years’ (or hours) of general clinical experience do you have?*
Are you trained in Psychological First Aid or Critical Incident Stress Debriefing and willing to provide Critical Incident Response services in your local area?*

YesNoUnsure
Do you have experience conducting workshops/training/seminars, and a willingness to provide trainings or orientations in our local area?*

YesNoUnsure
Are your rates for Critical Incident Response and Training different than your general clinical rate? Please provide relevant rate information. *
Please provide a resume or CV that demonstrates your years of clinical and/or EAP experience. *

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Please upload your highest educational degree received in a relevant field.

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FSEAP Affiliate Application Submission

Eligibility Screening Information

Affiliate Provider Contact Information

Virtual Practice Information

In Person Practice - Primary Office

In Person Practice - Secondary Offices

In Person Practice - Additional Secondary Office

Competencies and Training

Demographic Matching Questions