CAJ-1037 MDOC LEIN Request REV 09-2019.pdf
PDF 166 KB Posted
- Solicitation number
- RFQ 171 250000000052 2
- Issued by
- Livingston County, Michigan
About this file
This is a Criminal History Check Request Form (CAJ-1037) issued by the Michigan Department of Corrections (MDOC) for conducting background investigations through the Michigan Law Enforcement Information Network (LEIN). The form is used to screen individuals seeking access to MDOC secure facilities, including employees, contractors, visitors, and volunteers. Requestors must provide personal identification information including driver's license or state identification number, date of birth, race, and sex to facilitate the criminal history verification process. The form accommodates various categories of requestors, including HR personnel, contractors, visitors, and agency representatives, with a specific question regarding whether the individual will be entering the secure perimeter or property of an MDOC facility. The document references a project file number 472/19114.ABG related to a Newberry Upgrade Perimeter Security Head End Equipment initiative.
The form requires authorization from the individual to allow MDOC to conduct a comprehensive criminal history check and, for HR/employment purposes, permits the Department to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The LEIN clearance determination is documented on the form with yes/no indicators, and optional comments regarding conviction history may be included for HR employment purposes. The form does not establish pricing terms, set-asides, or funding information, as it functions solely as a background screening instrument rather than a procurement or service agreement document.
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Other files
| File | Type | Posted |
|---|---|---|
| 19114 - Addendum 1.pdf | ||
| 19114 Drawings.pdf | ||
| 19114 Advertisment.pdf | ||
| 19114 Specifications.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 Newberry Upgrade Perimeter Security Head End Equipment
File # 472/19114.ABG
File details come from the government source that posted it. Updated .