472-23130.SDW - MDOC LEIN Request.pdf
PDF 165 KB Posted
- Solicitation number
- RFQ-171-250000000253-2
- Issued by
- Washtenaw County, Michigan
About this file
This document is a Michigan Department of Corrections (MDOC) Law Enforcement Information Network (LEIN) Request form for a specific project at Woodland Center Correctional Facility involving a boiler replacement, identified by file number 472-23130.SDW. The form is designed to conduct criminal history checks for individuals seeking to enter secure MDOC facility perimeters, whether for employment, contracting, volunteering, or other authorized purposes. The form requires detailed personal identification information including full name, address, date of birth, sex, race, and either a driver's license or state identification number.
The form authorizes MDOC to perform comprehensive background checks, including criminal history verification and motor vehicle operator license review for individuals potentially working on or accessing the boiler replacement project. The specific project details are limited, but the form indicates it is related to a boiler replacement at Woodland Center Correctional Facility. Individuals completing the form must provide consent for background checks and provide accurate personal identification information. The form includes sections for MDOC personnel to record LEIN check results, including conviction status and additional comments, suggesting a thorough vetting process for project personnel.
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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: Woodland Center CF - Boiler Replacement File # 472/23130.SDW
File details come from the government source that posted it. Updated .