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Additional questions cover prior involvement with licensing or related agencies and references for respite, plus required certifications, signature confirmation, and return instructions to BeConnected Support Services Ltd.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/caregiver-application-form-1-basic-rev-0518/305984/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/caregiver-application-form-1-basic-rev-0518/305984.png","ImageObject",442,249,{"name":42,"@type":43},"Stanford","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-07","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What information does the Caregiver Application Form request from applicants?","Question",{"text":63,"@type":64},"It asks for applicant names, dates, phone numbers, email, who lives in the home, pets and smoking in the home, reasons for applying, relevant experiences, geographic location, languages spoken and fluency, and preferred gender to support.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What home-related details must be described?",{"text":68,"@type":64},"Applicants must describe their home and available space, including details such as bedroom/suite size, whether washrooms are shared or private, and what furnishings are included.",{"name":70,"@type":61,"acceptedAnswer":71},"What happens after submitting the application and what items are required?",{"text":72,"@type":64},"The application is kept on file for 6 months. If there may be a match, applicants complete a detailed application and interview; caregivers are subject to extensive screening including a detailed form, criminal record search, first aid/CPR certification, driver abstract, medical fitness, background references, home study, and authorizations, and applicants must submit their resume(s).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},305984,1790446288,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":22},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","CAREGIVER APPLICATION FORM 1-BASIC  \nApplicant(s) Name(s):    \nDate:   Phone No.:   Alternate Phone No(s).:    \nEmail:   Who lives in your home?  \nDo you have any pets?  \nDoes anyone smoke in your home? ☐ Yes ☐ No  \nWhy do you want to be a Home Living Caregiver?  \nWhat experiences do you bring?  \nGeographic location (What city / neighbourhood do you live in?):   \nLanguages Spoken and Fluency:  \nPreferred gender to support: ☐ Male ☐ Female  \nEst. 02/07 Page 1 of 3 NHL-008  \nRev. 03/08; 04/08; 02/09; 06/14; 02/15; 05/18  \nPlease describe your home and the space you have available. For example: size of bedroom / suite; shared or private washroom; furnishings included; etc.  \nDo you have a personal relationship with anyone affiliated with BeConnected Support Services (e.g. an  \nemployee, consumer, or family member)? ☐ Yes ☐ No  \nIf yes, please describe:  \n*Please note: Answering yes to this question will not disqualify your application.  \nHave you, or anyone living in your home, had any previous or present involvement with CLBC, MCFD, or  \nVIHA (Licensing)? ☐ Yes ☐ No  \nIf yes, please describe the involvement:  \nPlease provide the names, experiences, qualifications, and the geographic location of individuals and families you intend to use for respite.  \nCould you tell us who / where you were referred to BeConnected Support Services?  \nEst. 02/07 Page 2 of 3 NHL-008  \nRev. 03/08; 04/08; 02/09; 06/14; 02/15; 05/18  \nThank you for your application. We will keep it on file for 6 months. If we determine that your profile may be a match for an individual requiring service, we will ask you to complete a detailed application and come in for an interview. The screening requirements for caregivers are extensive.  \nPlease be aware that, if successful, you will be required to complete (non-exclusive):  \n1. A detailed application form  \n2. Criminal record search  \n3. Valid First aid/CPR certification  \n4. Driver Abstract  \n5. Medical Fitness  \n6. Background references  \n7. A thorough home study  \n8. Authorizations  \n9. Any additional as per NHL Checklist  \n􀀻 *Please remember to submit your Resume(s) with this application form to BeConnected Support Services.  \nCERTIFICATION  \nThis application is not valid unless the applicant(s) sign it.  \nI/We certify that the information provided in this application, attachments, resume(s) is true and  \ncomplete. I/We understand that this application is not a commitment by either BeConnected or applicant(s) and that the application process must first be completed. I/We understand that if any information in this application or attachments/resume is untrue or incomplete that my/our application will be rejected. I/We understand that if successful at acquiring contracting with BeConnected Support Services and in the future the information in my/our application is proven untrue, my/our contract will be terminated.  \nApplicant Signature:   Date:    \nCo-Applicant Signature:   Date:    \n􀂜 Thank you foryour interest in BeConnected Support Service’s Network of Home Living program. 􀂜 Please return your completed application form and Resume to BeConnected Support Services Ltd.:  \n- Victoria Office: 240-4243 Glanford Ave. Victoria BC, V8Z 4B9 Fax (250) 721-2571  \n- Duncan Office: 202-321 Festubert St., Duncan BC, V9L 3T1 Fax (250) 748-3859  \nEst. 02/07 Page 3 of 3 NHL-008  \nRev. 03/08; 04/08; 02/09; 06/14; 02/15; 05/18","cbCaijL8P2rchz0z","https://ap.wps.com/l/cbCaijL8P2rchz0z","pdf",446871,"English","# Applicant Information\n## Home and Household Details\n## Caregiving Experience and Preferences\n# Eligibility and Background\n## Relationships and Licensing Involvement\n## Respite References\n## Referral Source\n# Certification and Submission","[{\"question\":\"What information does the Caregiver Application Form request from applicants?\",\"answer\":\"It asks for applicant names, dates, phone numbers, email, who lives in the home, pets and smoking in the home, reasons for applying, relevant experiences, geographic location, languages spoken and fluency, and preferred gender to support.\"},{\"question\":\"What home-related details must be described?\",\"answer\":\"Applicants must describe their home and available space, including details such as bedroom/suite size, whether washrooms are shared or private, and what furnishings are included.\"},{\"question\":\"What happens after submitting the application and what items are required?\",\"answer\":\"The application is kept on file for 6 months. If there may be a match, applicants complete a detailed application and interview; caregivers are subject to extensive screening including a detailed form, criminal record search, first aid/CPR certification, driver abstract, medical fitness, background references, home study, and authorizations, and applicants must submit their resume(s).\"}]","Caregiver Application Form 1-Basic - Rev 05/18 | PDF",1789831732]