THIS APPLICATION IS FOR AN APPLICANT WHO IS 18 YEARS AND OLDER.


Please complete this application form if you are interested in becoming a Novant Health UVA Health System adult volunteer or year-round college volunteer. We are looking for a one year three-hour a week commitment.


SUMMER COLLEGE APPLICANTS: Our College Summer Application process opens in February with applications accepted until April 15th.



IMPORTANT: All volunteers are required to complete an annual TB questionnaire, annual mandatory education and have an annual influenza vaccination as a condition of volunteering.


LOCATIONS OF SERVICE: Prince William Medical Center, Haymarket Medical Center, Caton Merchant House, Aubergine Thrift Store, and Lake Manassas Cancer Center.


Once you complete the form, click the submit button at the bottom.



Name and Contact Information


Emergency Contact Information

Please Provide Your Emergency Contact Information. Please list two people who are able to make decisions on your behalf, if necessary.



Education

Please list your education, highest level completed, and your current student status, school attending, area of study, and expected graduation date, if applicable.



Volunteer/Work Experience

Describe other volunteer organizations and positions you may have held or currently hold and any previous or current employment. List organizations in which you are a member, to include any skills and talents you may have used in a volunteer or employment capacity.



Are you seeking employment? Yes or No


Availability and Interest

Please indicate the days and times you are usually available to volunteer. We will attempt to match your availability, as well as your interests and talents, with the volunteer opportunities that are currently available. We ask that volunteers make at least a one-year commitment to the Volunteer Services Program.



Types of Service

Please describe the type of volunteer service you are interested in providing (ie.patient/visitor service, clinical support, office/behind-the-scenes support, retail). If you are interested in being considered for a specific service area, please list that area. If you were referred to apply to a specific department, please list the department name and the name of the Novant Health UVA Health System team member who referred you.



Special Considerations

Our goal is to make the best possible match between your interests and abilities and our available volunteer opportunities.


1. Please list any health concerns that we need to keep in mind while considering certain volunteer positions (hearing, visual acuity, mobility issues, etc.)


2. Describe any current or anticipated situations that may affect your volunteer service or availability (school, travel, care of others, etc.)



The Mission of Novant Health UVA Health System

The Mission of Novant Health UVA Health System is to improve the health of communities one person at a time by delivering a remarkable patient experience in every dimension, every time. The Services Standards that we employ to create a remarkable patient experience are:

-Know me: I will be fully present and attentive when I am with you.

-Respect me: I will honor you as an individual.

-Care about me: I will be there for you in the way that you need.

-Delight me: I will think ahead and go the extra mile for you.


As a volunteer, how do you believe you can help achieve this mission and which of the four core service standards do you believe is most important and why? *This Section is REQUIRED*




How did you hear about us?

How did you hear about the Novant Health UVA Health System Auxiliary Volunteer Services Program? If you were referred by a current volunteer, employee, or physician please provide their name so we can thank them.



References

Please provide two professional or volunteer related references. References should be able to provide an objective description of your work ethic. Please be sure to list how you know the reference in the "relationship" field.

Family members or individuals who share the applicant's household may NOT serve as references.



Background Information

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:



Volunteer Agreement

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 UVA Health System 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.