26156.MDL LEIN Request.pdf
PDF 129 KB Posted
- Solicitation number
- RFP 171 260000001978 2
- Issued by
- Chippewa County, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Law Enforcement Information Network (LEIN) request form used to conduct criminal history background checks for individuals seeking access to secure facilities. The form is associated with the Chippewa Correctional Facility Sanitary Sewer Pretreatment and Infrastructure Upgrade project (File #472/26156.MDL). The LEIN request collects personal identifying information including name, date of birth, sex, race, and driver's license or state identification card number from applicants who need to enter the secure perimeter or property of MDOC facilities to perform work, conduct visits, meet with staff, or work with offenders. The form authorizes MDOC to complete a criminal history background check through LEIN as a condition of facility access approval.
For employment and human resources purposes, MDOC may additionally check motor vehicle operator license records to determine eligibility to operate vehicles while conducting Department business. The form includes fields for recording the number of convictions and optional comments regarding the background check results. A signature line indicates authorization from the applicant, and the form is completed and cleared by MDOC LEIN personnel with corresponding dates recorded. This document serves as a standard security and vetting procedure for the infrastructure upgrade project at the Chippewa Correctional Facility.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| SAMPLE Billable Rate Contract (Rev 04-25).pdf | ||
| 26156.MDL Addendum 1.pdf | ||
| Project Statement 26156.pdf | ||
| RFP 26156.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: Chippewa CF Sanitary Sewer Pretreatment & Infrastructure Upgrade File # 472/26156.MDL
File details come from the government source that posted it. Updated .