LEIN Check 24057.pdf
PDF 123 KB Posted
- Solicitation number
- RFP - 171 - 240000001181
- Issued by
- Ionia County, Michigan
About this file
This document is a Michigan Department of Corrections (MDOC) LEIN Request form, which is used to conduct criminal history checks on individuals seeking to enter the secure perimeter/property of an MDOC facility. The form requires the individual to provide personal information such as name, address, date of birth, sex, race, and driver's license or state ID number. The individual must also indicate whether they are entering an MDOC facility and authorize the MDOC to conduct a criminal history check and motor vehicle operator license record check.
The related state and local contract opportunity is for the Carson City CF - East Side Roofing project, located in Ionia County, Michigan. The project details, such as quantities, response dates, due dates, site visits, bidder's meetings and conferences, award dates, and contract term, are not provided in this document.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP 24057.pdf | ||
| Project Statement 24057.pdf | ||
| SAMPLE Billable Rate Contract (Rev 221207).pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: Carson City CF - East Side Roofing File # 472/24057.TYC
File details come from the government source that posted it. Updated .