CAJ-1037 MDOC LEIN Request REV 09-2019.pdf
PDF 173 KB Posted
- Solicitation number
- RFP-171-250000003010-3
- Issued by
- Alger County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC). The form is designed to facilitate a criminal history background check for individuals seeking to enter a secure MDOC facility, including contractors, visitors, volunteers, and other personnel. The form requires detailed personal identification information such as name, address, date of birth, race, sex, and either a driver's license or state ID number. Individuals must authorize the MDOC to conduct a criminal history check and, for employment purposes, allow review of their motor vehicle operator license record.
The form (CAJ-1037, revised 09/19) is specifically part of a project related to the Alger Correctional Cooler Freezer/Rooms, as noted in the red header. It provides a standardized mechanism for the MDOC to vet individuals who may interact with or work near offenders, ensuring security and compliance. The form includes sections for LEIN completion by authorized personnel, with checkboxes to indicate whether the background check is cleared and, for HR purposes, the number of convictions. The comprehensive nature of the form underscores the MDOC's commitment to maintaining a secure environment through thorough background screening processes.
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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):
BarschJ Text Box Facility/Project Name: Alger Correctional Cooler Freezer/Roofs File # 472/25256.JBB
File details come from the government source that posted it. Updated .