CAJ-1037 DOC LEIN Request REV 04-2018.pdf

This is a criminal background check authorization form used by the Michigan Department of Corrections (MDOC) to facilitate facility access for vendors and contractors. The form, designated CAJ-1037 REV. 04/18, is required for any individual seeking approval to visit or meet with persons confined in Michigan Department of Corrections facilities. Vendors and contractors must complete the form by providing personal identification information including their full name, address, date of birth, sex, and race. Additionally, applicants must supply either a Driver's License Number or State Identification Card Number issued by any state, as this information is necessary to conduct a comprehensive criminal history check through the Michigan Law Enforcement Information Network (LEIN). The form includes an authorization signature line where applicants consent to the MDOC conducting a criminal history check as a prerequisite for facility entry approval.

The form designates specific sections for MDOC staff use, including fields for documenting the reason for the LEIN check, the staff member requesting the check, the individual who conducted the LEIN check, and verification of whether the applicant cleared the background check. Applicants are informed that they may obtain copies of their Michigan criminal history through www.michigan.gov/ichat, though a fee applies for this service. The LEIN check must be completed and cleared before potential entry into MDOC facilities is granted. The form includes a file number field formatted as 472/_______._____ and a facility or project name field for documentation purposes.