472_24127_RLO_Oaks CF_PA System-Emergency Siren_Lein Clearance.pdf
PDF 191 KB Posted
- Solicitation number
- RFQ-171-250000000653-2
- Issued by
- Macomb County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC). The form is designed to conduct a criminal history check for individuals seeking to enter a secure MDOC facility, including contractors, volunteers, visitors, or other personnel. The form requires detailed personal identification information such as name, address, date of birth, race, sex, and either a driver's license or state identification card number.
The form authorizes the MDOC to perform a comprehensive background check, specifically to verify an individual's criminal history and, for employment purposes, to review their motor vehicle operator license record. The purpose is to determine an individual's eligibility to enter MDOC facilities, perform work, visit, or interact with offenders. The form includes checkboxes for different personnel categories, a section for identification details, and space for signatures and administrative processing by MDOC personnel. The document is marked with revision date 09/19 and carries the form code CAJ-1037.
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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: ________________________________ File # 472/_______.____
File details come from the government source that posted it. Updated .