Victim Services of Middlesex-London

VICTIM SUPPORT / INFORMATION: 519-661-5636

En français Translate Volunteer Login

If you are interested in becoming a Volunteer Crisis Responder, please fill out the on-line application form below.

Once an application is received the following will take place:

Phone Screening
In-person interview
CPIC and Vulnerable Sector Screening
3 Reference Checks (professional and personal)
Online and In-class training

An application will be kept on file for a maximum of twelve (12) months. If you are unable to join us in a training opportunity within that time, you will be asked to re-submit a volunteer application.

Your acceptance into the program is based on a completed application form, a successful interview (suitable temperament, experience, availability, etc.), acceptable security clearance and favourable references.

Volunteer Application Form

First Name

Last Name

Address

City

Province

Cell Phone

Are you over the age of 18, have a valid driver's license and access to a reliable car??

Yes

Highest level of Education

School

Program graduated from

Year

Please list relevant training courses

Course 1

Year

Course 2

Year

Course 3

Year

Employment status

Employed

Unemployed

Retired

Student

Current or Last Employer (or school if a student)

Job Title (or program if a student)

Volunteer Experience

Agency 1

Volunteer Role

Year

Agency 2

Volunteer Role

Year

Agency 3

Volunteer Role

Year

What are your hobbies

Any additional languages spoken?

Do you have a criminal record that you have not received a pardon?

Yes

If yes, please specify

ReferencesPlease note that Family Members are excluded

Work Supervisor Name

Work Supervisor E-mail Address

Work Supervisor Phone Number

Work Supervisor Occupation

Work Supervisor City

How long have you been acquainted to this Work Supervisor reference?

What is your relationship to your Work Supervisor reference?

Volunteer Supervisor Name

Volunteer Supervisor E-mail Address

Volunteer Supervisor Phone Number

Volunteer Supervisor Occupation

Volunteer Supervisor City

How long have you been acquainted with your Volunteer Supervisor Reference?

What is your relationship to your Volunteer Supervisor Reference?

Other Work/Volunteer Reference Name

Other Work/Volunteer Reference E-mail Address

Other Work/Volunteer Reference Phone Number

Other Work/Volunteer Reference Occupation

Other Work/Volunteer Reference City

How long have you been acquainted with your Other Work/Volunteer Reference?

What is your relationship with your Other Work/Volunteer Reference?

I hereby declare that the above information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from further consideration as a volunteer or result in dismissal.

Together we can make a difference.

We are always looking for volunteers and are grateful to our donors.

Volunteer

Donate

Become a Volunteer

Once an application is received the following will take place:

Together we can make a difference.