Buccan Provisions Volunteer Form

Buccan Provisions Volunteer Form
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you speak any other languages? *

Spanish Creole French
Please describe your professional background *
This volunteering opportunity involves working with food, therefore certain food safety standards must be followed, including guidelines on hair restraints, jewelry, and strictly controlled sanitation procedures. Will you comply with all instructions given by the food production manager on duty and understand that failure to comply will render you ineligible to participate. *

Yes No
Were you referred by a team member of the Ember Group (Buccan, Grato, Imoto)? *
Are you currently volunteering anywhere else? *

Yes, see next question No
If yes, where?
What are your personal goals for your involvement? *
I am available for the following times, please check all that apply: *

Monday 10pm – 2pm Monday 4pm – 8pm Tuesday 10pm - 2pm Tuesday 4pm- 8pm Wednesday 10pm - 2pm Wednesday 4pm-8pm Thursday 10pm-2pm Thursday 4pm-8pm Friday 10pm-2pm Friday 4pm-8pm
How many weeks are you able to commit to the above schedule? *
I plan on being out of town / unavailable to volunteer on the following days: *
This opportunity requires standing for the entire shift. Do you have any physical constraints that would prohibit you from doing this or other physical jobs? *

Yes, see next question No
If yes, please describe limitations:
Are you currently practicing social distancing? (For example: Wearing a mask, staying at least 6 feet from other people, not gathering in groups, staying out of crowded places and avoiding mass gatherings.) *

Yes No
Have you had any of the following symptoms in the past 24 hours? (Fever, Fatigue, Cough, Sneezing, Diarrhea, Sore Throat, Headache, Shortness of Breath, Runny or Stuffy Nose, Aches and Pains) *

Yes No
Have you traveled by airplane or cruise ship in the last 14 days? *

Yes No
Has anyone in your household traveled by airplane or cruise ship in the last 14 days? *

Yes No
Have you recently been in close contact with anyone who has tested positive for COVID-19? *

Yes No
Please list one Emergency Contact (include Name, Phone Number & Relationship) *
Please type your name as an Electronic Signature *
Should be Empty:

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