25139.ABG Kinross PA - MDOC-LEIN_RequestForm.pdf
PDF 83 KB Posted
- Attached to
- 472/25139. ABG; Kinross C. F. - PA Upgrades
- Solicitation number
- RFQ 171 260000000460 3
- Issued by
- Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Law Enforcement Information Network (LEIN) Request Form used to conduct criminal history checks for individuals seeking access to secure perimeters or facilities operated by MDOC. The form is designed to collect personal identification information, including driver's license or state identification numbers, date of birth, race, and sex, from employment applicants, contractors, visitors, volunteers, and other individuals requiring facility access. The form applies specifically to the Kinross Correctional Facility and relates to proposed PA (Protective Area) upgrades at that location.
The LEIN request form requires the applicant's authorization for MDOC to conduct a comprehensive criminal history check through the Michigan Law Enforcement Information Network. For employment or human resources purposes, the form additionally authorizes a motor vehicle operator license record check to determine eligibility to operate vehicles while conducting Department business. The form must be completed and signed by the applicant, with subsequent LEIN clearance documentation provided by MDOC personnel. No pricing, contract terms, funding sources, or renewal options are addressed in this clearance documentation form, as it functions solely as a pre-access screening instrument rather than a procurement or service delivery contract document.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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):
File details come from the government source that posted it. Updated .