Volunteer Application

Thank you for your interest in becoming a Fauquier Health Volunteer. Upon completing the application form, you will be contacted to discuss next steps. Two references will also be required. You can also mail hard copies of the application form and references to:

Fauquier Health Volunteer Services
253 Veterans Dr., Suite 206
Warrenton, VA 20186

Download Application Form Download Reference Form

Volunteer Application

First Name*

Last Name

Birthdate

Address (ex. 123 Main St., Warrenton, VA 20186)

Phone Number

Are you 18 years of age or older? Currently, we only have an adult volunteer program so you must be 18 years old to participate.YesNo

Do you have a Social Security Number? You will be asked to present the information for a background check prior to onboarding.YesNo

Do you have record of your immunizations (TDAP, COVID, Flu Vaccinations)? If you do not have these vaccinations, you may be able to sign a declination form during volunteer onboarding.YesNo

Level of completed education (choose one)

School

Graduation Year

Field of study

Work & Volunteer Experience

Most recent employer

Have you ever been employed by Fauquier Health?YesNo

List past volunteer experience:

Why do you want to volunteer at Fauquier Health? What are your interests (personal and professional)?

Please indicate the days and times you would be available to volunteer (ex. Monday-Wednesday between 1-4pm).

Criminal background checks will be performed on all volunteers aged 18 years and older. This information will be kept in strictest confidence. A criminal conviction will not necessarily bar you from being a volunteer. In making our decision, we will consider a variety of factors including the seriousness and nature of the offense and when the conviction occurred. Fauquier Health is a drug free/smoke free facility. A saliva based sample will be taken by our Employee Health nurse for drug testing.

By signing my name in the field below, I certify that information provided in this application is true in all respects without any willful omissions. I understand if information provided is false, I will be dismissed without notice regardless of when the falsification is discovered.

Todays date