26156.MDL Chippewa CF Sanitary Swr. & Infrastructure - MDOC-LEIN_RequestForm.pdf
PDF 83 KB Posted
- Solicitation number
- RFQ 171 270000000012 5
- Issued by
- Cass County, Kincheloe CDP, Michigan
About this file
This is a Criminal History Check Request Form (LEIN Request CAJ-1037) issued by the Michigan Department of Corrections (MDOC) for individuals requiring access to secure perimeters or properties at MDOC facilities. The form is used to facilitate background screening through the Michigan Law Enforcement Information Network (LEIN) for employment candidates, contractors, visitors, and volunteers who need to enter restricted areas or interact with MDOC offenders. The form collects personal identification information including driver's license or state ID number, date of birth, race, and sex, along with the requestor's full address and demographic details. Authorization is required from the individual to permit MDOC to conduct the criminal history check, and for employment purposes, additional authorization is requested to review motor vehicle operator license records to determine eligibility for operating vehicles during Department business.
The form includes sections for MDOC HR/Employment personnel or requesting contractors to indicate the number of convictions and optional comments following LEIN clearance. The document specifies approval status with checkboxes for "LEIN Cleared: Yes/No," with the notation that clearance determination does not apply to Human Resources processing. This form serves as a standard administrative tool to ensure security compliance and vetting procedures for all individuals seeking access to MDOC facilities, with completion and clearance documentation required before approval for facility access is granted.
View the file
Other files
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 .