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.

  • Eligibility Screening Information

  • Below are the standard eligibility criteria required in most provinces in order to meet the legislative or regulatory requirements. 

    1. Advanced degree in social work, clinical psychology, or related clinical mental health field

    2. Minimum of 3-5 years clinical counselling experience, ideally working with EAPs or within a short-term, solution focused, model of services

    3. Registered with regulatory college if required in your province, or similar member association in unregulated provinces

    4. Carry minimum malpractice and liability insurance coverage of $2,000,000

    5. Clear history with no criminal and practice charges or convictions, as well as no history or accusations of malpractice. 

  • Do you meet the eligibility requirements?*
  • Are there any current, or past, complaints against you filed with any licensing, certification, or other regulatory body?*
  • Have any malpractice suits, professional liability suits, arbitration, or other proceedings ever been instituted against you?*
  • Are you aware of any formal disciplinary or criminal charges convicted, or pending, against you?*
  • Are you registered to practice therapy in other provinces?
  • Do you offer in person therapy? Therapists providing in person services are preferred.*
  • Do you offer virtual therapy?*
  • What type of virtual therapy do you offer?*
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  • Affiliate Provider Contact Information

  • Practice Type*
  • Preference for Receiving Client Referrals*
  • Are you able to follow up on referrals within 1 business day of receiving them?*
  • Are you able to offer an appointment within 3-5 business days of receiving the referral?*

  • Virtual Practice Information

  • Rows

  • In Person Practice - Primary Office

  • Primary In Person Office Address*
  • Primary Office Address is located in*
  • Wheelchair Accessible?*
  • Accessible by Public Transportation?*
  • Parking Available?*
  • Rows
  • Do you have other secondary addresses?*

  • In Person Practice - Secondary Offices

  • Secondary Office Address is located in*
  • Wheelchair Accessible?*
  • Accessible by Public Transportation?*
  • Parking Available?*
  • Rows

  • In Person Practice - Additional Secondary Office

  • Secondary Office Address is located in
  • Wheelchair Accessible?
  • Accessible by Public Transportation?
  • Parking Available?
  • Rows
  • Do you have other secondary addresses? This location information will be gathered manually.*

  • Competencies and Training

  • Are you trained in Psychological First Aid or Critical Incident Stress Debriefing and willing to provide Critical Incident Response services in your local area?*
  • Do you have experience conducting workshops/training/seminars, and a willingness to provide trainings or orientations in our local area?*
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  • Demographic Matching Questions

  • FSEAP collects optional demographic information to help us better understand and support the diverse communities we serve. This data helps us ensure equity, identify gaps, and improve our services by matching clients with counsellors that meet their preferred demographics, if possible. Your responses are entirely optional—they will not affect your application in any way.

  • Date of Birth (Optional)
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  • Which of the following client groups can you provide therapy to?*
  • In which languages do you provide therapy?*
  • Which of the following presenting issues are you able to service?*
  • Do have the education/training, experience, and registration required to offer coaching services in any of the following areas?*
  • Do have the education/training, experience, and registration required to offer mediation or conflict resolution services?*
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