The process of becoming a volunteer at Novant Health is comprehensive, ensuring that individuals who wish to offer their time and skills are well-matched and thoroughly vetted to contribute positively to the health services provided. Rooted in Manassas, VA, the Novant Health Volunteer Application form is a gateway for adults, specifically those 18 years of age or older and not currently enrolled in high school, to step into various volunteer roles within the Novant Health Auxiliary at Prince William Medical Center and Haymarket Medical Center. The application requires potential volunteers to provide detailed personal information, availability preferences, and background details including employment and education history, as well as a self-disclosure regarding any criminal convictions or pending charges. This crucial step is designed to maintain the safety and integrity of the volunteering environment, considering the nature of the work within healthcare settings. Upon submitting the application—whether through email, mail, drop-off, or fax—candidates will be contacted for an interview, moving them forward in the process. The form underscores the importance of accurate and truthful information, with clear stipulations that any falsification or omission could disqualify the applicant from consideration or result in termination if discovered post-engagement. This structured application process highlights Novant Health's commitment to involving community members in their mission while ensuring compliance with legal standards and organizational needs.
| Question | Answer |
|---|---|
| Form Name | Novant Health Volunteer Application Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | novant volunteer application online, novant volunteer application, novant health volunteer application, novant volunteer application form |
Novant Health Auxiliary
Prince William Medical Center
Haymarket Medical Center
Adult Volunteer Application Form
(Application – 18 Years of Age or Older and not currently enrolled high school)
Once you have completed this application please scan and email, drop off, mail or fax it to the volunteer office as follows:
Scan and Email to: VolunteerNVA@novanthealth.org Mail/Drop off:
Fax:
Date:_____________________
Name:
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Date of Birth:_____ _/______ |
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AVAILABILITY
Please check the day(s) most convenient for you:
Sun Mon Tue Wed Thu Fri Sat
Morning
If you have a preference for a service area and/or location (for
more information please review the document titled “Volunteer information” found on our webpage:
www.NovantHealth.org/pwvolunteer) please specify below:
Afternoon |
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Please enter the date you can start work: |
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BACKGROUND INFORMATION
Employment: Are you currently employed? ______ |
If yes, please provide details: |
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Supervisor |
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Briefly describe your responsibilities:
Education: Are you currently enrolled in school? (enter Yes or No) ___________
If yes what school: |
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History: Pursuant to the Code of Virginia all applicants must affirmatively identify any criminal conviction or pending criminal charge whether within or outside the Commonwealth of Virginia. Furthermore, all applicants will be required to provide a sworn statement disclosing any criminal convictions or any pending criminal charges. Applicants are not required to disclose arrests, charges or convictions that have been expunged. Conviction of a crime is not an absolute bar to volunteering. We will take into account the nature and gravity of the offense or offenses, the frequency of the offenses and the interval between them, the time that has passed since the conviction and/or completion of sentence, and the nature of the volunteer work for which the applicant has applied. With that information in mind, please answer the following:
Have you ever been convicted of a crime other than a minor traffic violation? (enter Yes or No) ___________
Do you have any criminal charges pending against you? (enter Yes or No) __________
If you answered yes to either of these questions, please explain, including the type of crime(s) involved.
I certify that the information contained in this Volunteer Application is correct and complete to the best of my knowledge. I understand that Novant Health may investigate my background by contacting persons or entities identified in my application, or others, or by examining any public records or other available information about me, including conviction records. Furthermore, I understand that I will be required to provide a sworn statement disclosing any criminal convictions of any pending criminal charges. I understand that falsification, misrepresentation or material omission of facts called for in this application will be grounds for disqualification from further consideration or will result in termination of my volunteer position without notice.
Signature:Date:
For office use only:
Volunteer I.D. Number: _____________________________________
Date Joined: ______________________________________________
Hospital Orientation for Volunteers: __________________________
Starting Date: _____________________________________________
Assignment: Service Area/Day/Shift: _________________________
Chairperson Notified of Start: ________________________________
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