CAJ-1037 DOC LEIN Request REV 04-2018.pdf
PDF 30 KB Posted
- Solicitation number
- RFQ-171-190000000347-4
- Issued by
- Macomb County, Mcbride Village, Michigan
About this file
This document is a Michigan Department of Corrections (MDOC) Vendor/Contractor LEIN (Law Enforcement Information Network) Request form, specifically the CAJ-1037 revision from April 2018. The form is designed to facilitate a criminal history background check for vendors or contractors who require access to MDOC facilities. The form requires individuals to provide personal identification details, including name, address, date of birth, sex, race, and either a driver's license or state identification number. Individuals must authorize MDOC to conduct a criminal history check to be approved for visiting or meeting with persons confined in a Michigan Department of Corrections facility.
The form includes sections for staff-only use, where MDOC personnel will document the reason for the LEIN check, verify the criminal history clearance, and record administrative details. If an individual does not clear the LEIN check, they are directed to obtain a copy of their Michigan criminal history through the state's online portal (www.michigan.gov/ichat), which requires a service fee. The form is part of MDOC's standard security protocol to ensure that vendors and contractors entering correctional facilities have been vetted through a comprehensive background screening process.
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 04/18
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 is needed to complete this LEIN. Also needed are your date-of-birth, race and sex. Potential entry into MDOC facilities require that this LEIN check be completed and cleared.
Profession Vendor Contractor
Last Name (Please Print) 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 Michigan Department of Corrections to conduct a criminal history check, so that I may be approved to visit/meet with persons confined in a Michigan Department of Corrections facility.
Signature Date
Staff Use Only
Reason for LEIN Check
Staff requesting LEIN Check
LEIN Checked by
LEIN Clear Yes No, You may obtain a copy of your Michigan criminal history at www.michigan.gov/ichat. There is a fee for this service.
LEIN Check completed by Initials Date http://www.michigan.gov/ichat hallt2 Text Box Facility/Project Name: ________________________________ File # 472/_______.____
File details come from the government source that posted it. Updated .