25259 Kinross Buffer Fence - LEIN Request.pdf
PDF 165 KB Posted
- Solicitation number
- RFQ-171-250000000618-1
- Issued by
- Clare County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC) specifically related to the Kinross Correctional Facility's Buffer Fence & Entrance Gate project (File #472/25259.ABG). The form is designed to facilitate a criminal history background check for individuals seeking to enter a secure MDOC facility, whether as an employee, contractor, volunteer, or visitor. The form requires detailed personal identification information, including driver's license or state ID number, date of birth, race, sex, and authorizes MDOC to conduct a comprehensive criminal history check.
The primary purpose of this document is to enable MDOC to screen and approve individuals for access to correctional facility premises, with specific provisions for checking criminal records and, in employment contexts, motor vehicle operator license records. The form allows for different categories of entry (contractor, volunteer, visitor, etc.) and requires the individual's authorization to conduct these background checks. The document includes sections for MDOC personnel to complete the LEIN check, indicate clearance status, and note the number of convictions, providing a standardized process for vetting individuals who may interact with or work within MDOC facilities.
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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: Kinross Correctional Facility - Buffer Fence & Entrance Gate File # 472/25259.ABG
File details come from the government source that posted it. Updated .