CAJ-1037 DOC LEIN Request REV 04-2018.pdf
PDF 30 KB Posted
- Attached to
- 472/17433. JAG-Central MI CF-Generator Bldg. Improvements State and local contract opportunity
- Solicitation number
- RFQ 171 190000000608 3
- Issued by
- Gogebic County, Michigan
About this file
This is a vendor/contractor LEIN (Law Enforcement Information Network) request form from the Michigan Department of Corrections (MDOC). The form is required for vendors and contractors seeking access to MDOC facilities, specifically for the Central Michigan Correctional Facility Generator Building Improvements project (File # 472/17433.JAG). The LEIN check is a mandatory criminal history verification process that must be completed and cleared before any vendor or contractor is permitted to visit or meet with persons confined in Michigan correctional facilities. The form requests standard identification information including driver's license or state identification card number, date of birth, race, and sex to facilitate the background check through the Michigan Law Enforcement Information Network.
The form serves as authorization for MDOC to conduct a criminal history check on the applicant and includes sections for staff use only, documenting who requested the LEIN check, who conducted it, and whether the applicant cleared the background screening. Applicants may obtain a copy of their Michigan criminal history through www.michigan.gov/ichat, though a fee applies for this service. The LEIN check clearance is a prerequisite for facility access and must be completed before any work or vendor activities can commence on the Generator Building Improvements project at Central Michigan Correctional Facility.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Specifications.pdf | ||
| Advertisment.pdf | ||
| Architectural Plans.pdf | ||
| Bid Addendum 2.pdf | ||
| Electrical Plans.pdf | ||
| Addendum 1 17433.pdf | ||
| Civil Plans.pdf |
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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: Central Michigan Correctional Facility - Generator Building Improvements File # 472/17433.JAG
File details come from the government source that posted it. Updated .