Buccan Provisions Volunteer Form
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
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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
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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.
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Yes
No
Were you referred by a team member of the Ember Group (Buccan, Grato, Imoto)?
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Are you currently volunteering anywhere else?
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Yes, see next question
No
If yes, where?
What are your personal goals for your involvement?
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I am available for the following times, please check all that apply:
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Monday 9am – 12pm
Tuesday 9am - 12pm
Wednesday 9am - 12pm
Thursday 9am-12pm
Friday 9am-12pm
How many weeks are you able to commit to the above schedule?
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I plan on being out of town / unavailable to volunteer on the following days:
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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?
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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.)
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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)
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Yes
No
Have you traveled by airplane or cruise ship in the last 14 days?
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Yes
No
Has anyone in your household traveled by airplane or cruise ship in the last 14 days?
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Yes
No
Have you recently been in close contact with anyone who has tested positive for COVID-19?
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Yes
No
Please list one Emergency Contact (include Name, Phone Number & Relationship)
*
Please type your name as an Electronic Signature
*
Submit
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