CAJ-1037 MDOC LEIN Request REV 09-2019.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ-171-200000000311-2
- Issued by
- Benzie County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) request form (CAJ-1037) from the Michigan Department of Corrections (MDOC) associated with a project to replace vigilant fire alarm systems and smoke detectors at Handlon and Lakeland Correctional Facilities (File #472/20007.RWG & 472/20011.RWG). The form is used to conduct criminal history checks for individuals who need to enter MDOC facilities, including employees, contractors, visitors, and volunteers. The document requires personal identification information including driver's license or state ID number, date of birth, race, sex, and complete contact information.
The form requires authorization for MDOC to conduct criminal background checks for facility access and, specifically for HR/Employment purposes, motor vehicle operator license record checks. The form includes sections for LEIN completion verification, clearance status, and conviction records for employment purposes. No specific pricing terms, set-asides, or funding information is included in this document as it appears to be a standard security clearance form required for facility access.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Drawings - Lakeland - Part 2.pdf | ||
| Drawings - Handlon - Part 1.pdf | ||
| DTMB-0415 (Advertisment)(R11-19).pdf | ||
| Drawings - Handlon - Part 2.pdf | ||
| Drawings - Lakeland - Part 1.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
LEIN REQUEST
CAJ-1037.
REV. 09/19.
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, date-of-birth, race and sex is needed to complete this LEIN request.
Employment/Human Resources HR Personnel / Requesting
Contractor Visitor Contractor Agency Agency Representing
Volunteer Other Agency Representing Agency Representing
Are you entering the secure perimeter/property of a Michigan Department of Corrections (MDOC) facility? Yes No
Please print information below:
Last Name: 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 MDOC to conduct a criminal history check, so that I may be approved to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with or work with MDOC offenders.
For MDOC HR/Employment purposes only: I further authorize the Department to check my motor vehicle operator license record for the purposes of determining if I will be allowed to operate a motor vehicle while conducting Department business.
Signature: Date:
LEIN Completed By: Name: Date:
LEIN Cleared: Yes No (Does not apply to Human Resources)
MDOC Employment/HR purposes: Indicate the # of convictions:
Comment (Optional):
hallt2 Text Box Facility/Project Name: Handlon & Lakeland CF - Replace Vigilant Fire Alarm System - Smoke Detectors File # 472/20007.RWG & 472/20011.RWG
File details come from the government source that posted it. Updated .