MyImpactPage - Application Form

Important Information Before Applying

Applicant Acknowledgement

I understand that the Respite Companion Program is a paid independent contractor opportunity and not a volunteer role or an employment position with Niagara Region. Hours are variable, not guaranteed, and should only be relied upon as supplemental income. I confirm that I have my own vehicle and a valid Canadian driver's licence. I understand that clients served through the Respite Companion Program are living with dementia, memory loss, and/or related cognitive changes, and that this role requires patience, flexibility, respect, and a person-centred approach. I also understand that approval as a Respite Companion Contractor is subject to successfully completing all required screening, interview, orientation, training, and practical learning components.

Privacy statement

In accordance with our privacy policy, Seniors Community Programs will not under any circumstances use any information provided on this form for any purpose that is inconsistent with the purpose for which the information was provided. Personal information will be collected, used and disclosed by Niagara Region Community Services in accordance with the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA).

I am new to MyImpactPage.com

You will need to enter a unique username to identify yourself to the system. You should select something that is easy for you to remember such as your email address or your name. Your username must be at least 6 characters long. If the name you enter is already in use by someone else, you will be prompted to choose another username.

Username

Required

Username must not start with space

Username must not end with space

Username must not have two or more spaces in a row

Email Address

Required

Verify Email Address

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I have read and understand the application requirements Required

I already have a username

If you have signed up with this organization before, or are a member of another organization that uses MyImpactPage.com, you can use the same login to access all organizations with which you are associated.

Username Required

Password

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I have read and understand the application requirements Required

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