New Hire/Intern/AmeriCorps Form

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General Information

Include Apartment or Unit Number separated by a comma

This is information is used to create your unique Online Access Code so you can log into your personal CAN portal.

For grant writing and other data collection purposes

Employment History
Please start with your most recent employment and, if applicable, add additional employers (up to 3).

123 Practice Lane, Ypsilanti, MI 48197

Please share your education and any additional qualifications you believe are relevant to the position.
High School                                                                          

e.g. Zeeland East, Zeeland, Michigan or Elmwood School, Ottawa, Ontario, Canada

That you are currently attending or from where you acquired your degree

Please provide the name, contact information, and position of two professional* references.

*Relatives/family members are not accepted as references. 
Reference #1

123 Practice Lane, Ann Arbor, MI 48105

Reference #2

123 Praactice Lane, Ann Arbor, MI 48105

In this section, by uploading your photo and checking the box, you are declaring all of the information you provided is accurate and give CAN permission to use your image for our staff ID and to contact your previous employers and references.

Is there anything else you would like to share?
You will be asked to submit an E-Signature on the following page.
COVID-19 Vaccination Requirements (Archived)
At Community Action Network (CAN), our mission is to partner with under-resourced families so they can thrive. A large component of this is ensuring we are doing everything in within our power to protect the vulnerable populations who are the most susceptible to the devastating effects of this virus.

Some ways we work together to prevent the incubation and spread of COVID-19 and its variants are by wearing masks and requiring vaccinations. The vaccine is safe, effective, and remains the best tool in preventing severe illness, hospitalizations, and death.

For staff, interns, and volunteers who partner with CAN and CAN's families, the COVID-19 vaccine & eligible boosters are required. 

Please review CAN's COVID-19 Response Plan and contact if you have any questions.
CAN Definitions
  • Fully Vaccinated = Completed initial vaccine series + current eligible boosters

  • Partially Vaccinated = Some amount of vaccine completion, but not current eligible boosters

  • Not Vaccinated = Has not completed the initial vaccine series nor the boosters
Please review this website to check if you are up to date on the COVID-19 vaccine series and eligible boosters:

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