City of London - Dearness Home Volunteer Application

Note: Fields marked with ★ are mandatory.

Thank you for your interest in volunteering with Dearness Home. Volunteers play an important role in enhancing the quality of life for our residents in the Long Term Care Home and our clients in our Adult Day Program through companionship, activities, and meaningful connections. We appreciate your time and interest in joining our volunteer team as we work together to enrich the lives of others with compassion.

Once your application has been submitted, it will be reviewed by our Volunteer Coordinator. If your interests and availability match our current volunteer opportunities, we will contact you to discuss next steps.

We sincerely appreciate your interest in sharing your time and compassion with our residents.

We are committed to providing a fully accessible application process. Please let us know if you require any accommodation: accessibility@london.ca.

Section 1 - Personal information

First Name

Last Name

Preferred Name (optional):

Preferred Pronouns (optional):

Address:

E-mail address:

Phone Number:

Please list any languages you speak that you would be comfortable using in your volunteer role at Dearness:

Please list your emergency contact:

First Name:

Last Name:

Relationship:

Phone Number:

Section 2 - Eligibility

I confirm:

I am at least 14 years of age

Dearness Home appreciates your interest in volunteering! Please note: we require all volunteers to be a minimum of 14 years of age. Applicants 15 years of age and under must have signed parental or legal consent.

Would you like your application to be kept on file for six months if we currently do not have any open positions?

Section 5 - We'd Love to Get to Know You

Help us get to know you a little better so we can create a meaningful volunteer experience together.

What interests you most about volunteering at Dearness Home (select all that apply):

Give back to my community
Meet volunteer requirements for school, college, or university
Build meaningful connections with older adults
Gain volunteer or work experience
Develop new skills
Share my skills and interests with others
Explore a career in healthcare, recreation, or a related field

Other:

What is something about yourself such as a hobby, talent, life experience, or interest that you would enjoy sharing with our residents?

Tell us about a time when you helped someone feel welcome, included, or at home. What did you do, and what did you learn from that experience?

If one of our residents described you after spending time together, what would you hope they would remember the most about you?

Section 6 - Declaration

If accepted as a volunteer, I understand that I will be required to complete the following before starting:

Provide two references
Complete a two-step TB check at my own cost
Complete a Vulnerable Sector Check at my own cost
Attend Volunteer Orientation and required training
Commit to a minimum of two volunteer shifts per month

I confirm that all information provided in this application is true and complete to the best of my knowledge:

I confirm

Submitter E-mail (In case we need to reach you regarding this submission)

The personal information collected on this application form is collected under the authority of the Municipal Act, 2001 and will be used to assist City of London Dearness Home in administering the Dearness Home Volunteer Program. Questions about this collection may be referred to the Manager, Community Life, Social and Health Development, Dearness Home, 519-661-2489 ext. 8271 or cgilmour@london.ca.

Note: If the form does not appear to submit, please open each section and confirm that there are no issues or missing required fields.

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The verification code is: four, India, November, November, seven.