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.

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Other files for this state and local contract opportunity

Other files attached to 472/17433. JAG-Central MI CF-Generator Bldg. Improvements, newest first.
File Type Posted
Specifications.pdf PDF
Advertisment.pdf PDF
Architectural Plans.pdf PDF
Bid Addendum 2.pdf PDF
Electrical Plans.pdf PDF
Addendum 1 17433.pdf PDF
Civil Plans.pdf 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 .