HCA Return of Service Fulfillment Confirmation

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HCA: Return of Service Fulfillment Confirmation

This form is for participants of the Health Care Assistant Recruitment Incentive Program who have completed their twelve-month return of service commitment. By completing this form, program participants are providing written confirmation to the Ministry of Health that their return of service period has been fulfilled. Please complete the form below, and attach relevant documentation where required.

Personal Information

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Return of Service Fulfillment

Return of Service Start Date Missing or incorrect valuePlease reference your signed Return of Service Agreement. Your start date begins on the day you signed your agreement.
Return of Service End Date Missing or incorrect valueThis is one year from the return of service start date (unless you have received an approved extension)
Please attach proof of continuous employment in your HCA position during the Return of Service period. Participants can access the return of service completion template at the Choose2Care site or may submit alternative proof as long as it includes the applicant’s employment start date, the current date, employer letterhead and employer signature (e.g., automatically generated employment verification letter).
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Note: if you are currently working as an HCA (or equivalent) for multiple employers, the Ministry of Health requires a completed and signed copy of the Return of Service Completion Letter (or acceptable alternative as above) from each of your employers. If you changed employers during your Return of Service period, a letter is only required from your current employer.

Personal information is collected via this form under sections 26(c) and (e) of the Freedom of Information and Protection of Privacy Act (FOIPPA) for the purposes of administering the Health Care Assistant Recruitment Incentive Program.
 
Personal information will only be used by authorized personnel to fulfill the purpose for which it was originally collected or for a use consistent with that purpose unless you expressly consent otherwise. We do not disclose your information to other public bodies or individuals except as authorized by FOIPPA.
 
If you have any questions about our collection or use of personal information, please direct your inquiries to the Director, Strategic Initiatives, Labour and Agreements, 1515 Blanshard Street, Victoria, British Columbia, V8W 3C8. Telephone: 236-478-3520, Email: HCAincentive@gov.bc.ca.

Consent and Affirmation

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Keep a Copy for Your Records (optional)

To protect your personal information from third parties, we will not send you a copy of this form by email. If you want to keep a copy for your records, you can download a copy using the PDF button below.

Questions?

For questions regarding this form, please contact HCAincentive@gov.bc.ca.

Submit Your Form

Use the submit button to send your HCA Return of Service Fulfillment Confirmation form to the Ministry of Health. We will contact you within 3 weeks regarding your confirmation.
HLTH 8104  2021/07/29
2876790ad9fc3475367c1fbff5b50efc2037ef73
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