CAJ-1037 DOC LEIN Request REV 04-2018.pdf
PDF 31 KB Posted
- Solicitation number
- RFP 171 190000000984 2
- Issued by
- Cass County, Kincheloe CDP, Michigan
About this file
This is a criminal history check request form issued by the Michigan Department of Corrections (MDOC) for vendors and contractors requiring access to MDOC facilities. The form, CAJ-1037 (Revised April 2018), is used to initiate a background check through the Michigan Law Enforcement Information Network (LEIN) for individuals seeking approval to visit or meet with persons confined in Michigan correctional facilities. Vendors and contractors must complete the form by providing personal information including full name, date of birth, address, sex, and race, along with at least two forms of state-issued identification such as a driver's license or state identification card number. The form requires authorization from the applicant to conduct the criminal history check and must be completed and cleared prior to any facility access.
The LEIN check process is managed by MDOC staff who verify clearance status and document completion. No pricing, contract terms, or funding information is applicable to this form, as it functions solely as a prerequisite administrative document for vendor and contractor access to correctional facilities. Applicants may obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee. The form requires documentation of the facility or project name and file number for record-keeping purposes.
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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 at least two of the following three 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 .