Homeshare Provider Application - First Step

If you have reviewed the CLBC online information page which helps clarify the roles and expectations of the home share provider, and explains the CLBC standards and policies, and you think you would be a good candidate, the next step is to complete this the comprehensive application form.

Building Bridges only approves those with the skills, disposition, and physical accommodation to provide high-quality home share support to adults with diverse abilities.

In addition to this application, a home share coordinator will complete a rigorous and comprehensive assessment prior to approving any home share provider. Approval does not necessarily guarantee that a contract will be established with the potential provider. Contracts will be established when the individual, their family, or support network members decide whether or not a potential candidate meets the individual’s needs and preferences for support.

Home share providers contracted with Building Bridges only support one individual at any given time. Exceptions can be considered if the situation is compatible to the first individual in the home.

NOTE: This application form may take more than one sitting is complete. If you run out of time to complete the form, choose “Save for Later” at the bottom of the form before you submit it. Upon submission, you’ll receive an email with a link to complete the form.

Application Date*
Month
Day
Year
Primary Applicant
Name*
First Last Other names
Birth Date*
Month
Day
Year
Email*
Primary Phone Number*
Alternate phone number
Work Phone
Current Employer
Employer Position Title Length Employed With
What languages are you fluent in?
Are You A Building Bridges Employee?
- Yes
Secondary Applicant (Secondary Caregiver)
Name
First Last Other Names
Birth Date
Month
Day
Year
Primary phone number
Alternate phone number
Work Phone
Current Employer
Employer Position Title Length Employed With
What languages are you fluent in?
Are You A Building Bridges Employee?
- Yes
Tell us why you want to become a Home Share Provider
What do you know about being a home share provider for an adult with diverse abilities?*
Why are you considering becoming a home share provider at this time?*
Will others be impacted by this decision (children, partner, others living in the home, etc.)? If so, have they been consulted and are they supportive of the choice?*
How long are you willing to commit to being a home share provider?*
Will you be sole home share provider supporting the individual, or will others in the home be sharing the responsibility?
- I will be the sole home share provider.
- Others in the home will be helping with the home share provider role.
If others will be sharing the home share responsibilities, please name them, and to what capacity they will be sharing the responsibilities.
Tell us about yourself and those who live within the home
Describe your own strengths, interests, and hobbies. How would these contribute to you being a good home share provider?
What is your marital status?
- Single
- Common Law
- Married
- Divorced/Separated
- Other
If you have/live with a spouse/partner, how long have you been together? How did you meet them?
List those who currently live within the home. Provide details about their relationship to the primary applicant and their birthdates.
How are you and your family involved in your community (sporting/leisure activities, clubs/associations, volunteer work, etc.)? Describe the nature and level of your participation.
Are you affiliated with any specific religious/cultural organizations? Describe the nature and level of your participation.
Do you or any members of the household smoke?
- I smoke.
- Others in the household smoke.
- No one in the household smokes.
Would you be willing to support someone who smokes?
- Yes, they can smoke in the house.
- Yes, but they can only smoke outside.
- Yes, but they have to smoke off the property.
- No, we are a smoke-free household.
Do you or any members of the household have chronic or communicable health conditions? If so, please describe.
Do you take regular holidays?
- Yes
- No
How would your decision to become a home share provider impact your overall lifestyle, regular schedule, commitments, and priorities?
Describe how often and for how long you tend to go on holidays? How will becoming a home share provider impact this practice?
Briefly outline your work history. Highlight any work experiences that are relevant to supporting individuals with diverse abilities.
Please attach full resume
Your Resume/CV
Drop files here or

Accepted file types: doc, docx, pdf, pages, txt, odp, gdoc, , Max. file size: 888 MB.
List the members of your household who are currently employed. Provide details about their current employer, position, length of employment, and work schedule.
Have you ever done home share, foster care, or respite support? If so, please provide details (agency name, dates, etc.).
Have you ever held a position or contract with Community Living BC, the Ministry of Children and Family Development, or any other community support agency? If so, please provide details (agency name, dates, etc.).
Are you currently supporting an individual with a diverse ability in your home? If so, please provide details.
What other agencies, if any, are you approaching to become a home share provider?
Have you been screened (partially or completely) by another service provider to become a home share provider? If so, please provide details.
Would you be comfortable supporting someone with complex needs? Please check the items you would be willing to support:
- Addictions issues
- Aggressive behaviour
- Augmentative communication
- Blind, deaf
- Chronic anxiety
- Communicable health conditions
- Dementia
- Diabetes
- Diet management
- Disrupted sleep
- Incontinence
- Intensive behaviour
- LGBQT
- Loud, shouting
- Medication compliance
- Mental health support needs
- Mobility/physical disability
- Personal care
- Seizure disorder/epilepsy
- Sexual inappropriateness
- Smoker
- Stealing
- SuicidalWandering, running away
Are there any other specific disabilities or challenges (not mentioned above) which you are not comfortable with?
If you become a home share provider, what support/training do you think you will need to be successful?
Tell us about your home
Do you own or rent your home?
- Rent
- Own
What kind of home do you have (condo, apartment, townhouse, detached home, etc.)? Briefly describe the home (square footage; one/two/three storey; number of bedrooms, bathrooms; layout/design features, etc.) and the exterior space.
Does the home have any features that might limit or improve accessibility for someone with a physical disability or mobility challenges? Please describe.
Describe your vehicles (model, reliability, availability).
Describe the parking situation for your home (i.e. street, garage, driveway. etc.). Is there any extra parking if the individual has their own vehicle?
Are there pets in the home? If so, please provide details (type, breed, age, and disposition).
If the individual has a pet, will they be able to have it in your home?
- Yes
- No
- It depends (describe conditions in "Other" box)
Describe your neighbourhood and provide details about proximity to services (schools, parks, community centers, shopping facilities, public transportation, leisure/recreation opportunities, etc.).
How long have you lived in this neighbourhood? Why did you choose to settle there?
In Closing
Anything further you would like us to know?
Primary Applicant's References*
Please provide 3 references.
Name Contact number Email Relationship to you How long they have known you for
Secondary Applicant's References
Please provide 3 references.
Name Contact number Email Relationship to applicant How long they have known you for
Declaration and Consent*
By checking beside the statement, you are agreeing to that statement.
- Select All
- I/we declare that the information contained in this application is true to the best of my/our knowledge and believe that I/we have not omitted any pertanent information.
- I/we understand that the information provided is required to ensure that I/we are qualified to be considered as a home share provider. Any false statement will invalidate the submission or my/our status as a home share provider.
- I/we confirm that the information provided in this application was provided voluntarily for the purposes of determining my/our eligibility to be a home share provider.
- I/we give permission for Building Bridges Community Support to contact the individuals listed in the references section of this form.
- I/we give permission for Building Bridges Community Support to obtain a reference from any agency that I/we have named as a previous/current employer or contractor within the community support sector. This may include CLBC, MCFD (or its predecessors), or other community support agencies and may be in addition to the references named above.
- I/we understand that under the BC information and privacy laws, that I/we can revoke my/our permission for Building Bridges to use this information, or to obtain information from the above stated individuals/agencies at any time.
If there is a primary and secondary applicant, both must sign below.
Primary Applicant's Name
First Last
Signature
Date
MM slash DD slash YYYY
Secondary Applicant's Name
First Last
Signature
Date
Month
Day
Year
Building Bridges Review
For Office Use Only
Name of Reviewer
First Last Title
Date of Review
Month
Day
Year
Strengths
Areas for Improvement/Concerns
Items that require follow-up
Comments
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Homeshare Provider Application – First Step

Primary Applicant

Secondary Applicant (Secondary Caregiver)

Tell us why you want to become a Home Share Provider

Tell us about yourself and those who live within the home

Tell us about your home

In Closing

If there is a primary and secondary applicant, both must sign below.

Building Bridges Review

Contact Us

Name	Contact number	Email	Relationship to you	How long they have known you for

Name	Contact number	Email	Relationship to applicant	How long they have known you for