23312 LEIN Request.pdf
PDF 160 KB Posted
- Solicitation number
- RFP - 171 - 230000002394
- Issued by
- Luce County, Michigan
About this file
This document is a LEIN Request form from the Michigan Department of Corrections. The form is used to request a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for individuals who need to enter the secure perimeter or property of a Michigan Department of Corrections facility to perform work, visit, meet with, or work with offenders. The form requires the individual's personal information such as name, address, date of birth, sex, race, and driver's license or state ID number.
The related state and local contract opportunity is for an Electrical Infrastructure Assessment at the Newberry Correctional Facility, located in Luce County, Michigan. The contract opportunity has the file number 472/23312.ABG.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| SAMPLE Billable Rate Contract (Rev 221207).pdf | ||
| 23312 RFP Billable Rate.pdf | ||
| 23312 Project Statement.pdf | ||
| 23312 Facility One Line Diagram.pdf | ||
| 23312 Addendum 1.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
LEIN REQUEST
CAJ-1037.
REV. 09/19.
Please provide the information requested below. This information will be used to complete a criminal history check in the Michigan Law Enforcement Information Network (LEIN).
Your Driver’s License Number or State Identification Card Number, date-of-birth, race and sex is needed to complete this LEIN request.
Employment/Human Resources HR Personnel / Requesting
Contractor Visitor Contractor Agency Agency Representing
Volunteer Other Agency Representing Agency Representing Are you entering the secure perimeter/property of a Michigan Department of Corrections (MDOC) facility? Yes No
Please print information below:
Last Name: First Name: Middle Name:
Address:
City: State: Zip Code:
Date of Birth: Sex: Race:
Please provide the number of one of the following types of identification:
Driver’s License #: State issued by:
State ID #: State issued by:
I authorize the MDOC to conduct a criminal history check, so that I may be approved to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with or work with MDOC offenders.
For MDOC HR/Employment purposes only: I further authorize the Department to check my motor vehicle operator license record for the purposes of determining if I will be allowed to operate a motor vehicle while conducting Department business.
Signature: Date:
LEIN Completed By: Name: Date:
LEIN Cleared: Yes No (Does not apply to Human Resources)
MDOC Employment/HR purposes: Indicate the # of convictions:
Comment (Optional):
hallt2 Text Box Facility / Project Name: Newberry Correctional Facility - Electrical Infrastructure Assessment File # 472/23312.ABG
File details come from the government source that posted it. Updated .