LEIN Check - Phase Two.pdf
PDF 25 KB Posted
- Attached to
- 472/16399. JAG - Central MI CF-Pavement - Phase Two State and local contract opportunity
- Solicitation number
- RFQ 171 180000000380 2
- Issued by
- Gogebic County, Sterling Heights City, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Check form issued by the Michigan Department of Corrections for vendor and contractor background clearance in relation to the Central Michigan Correctional Facility Pavement Improvements - Phase Two project (File #472/16399.JAG). The form requires vendors and contractors seeking access to MDOC facilities to complete a criminal history background check as a condition of approval to visit or meet with confined individuals. The form requests standard identification information including driver's license number or state identification card number, social security number, date of birth, race, and sex, along with contact information and professional designation.
Completion of the LEIN check and clearance is mandatory for potential entry into MDOC facilities. Applicants must provide at least two of three forms of identification: driver's license, state-issued identification card, or social security number. The authorization granted on the form permits the Michigan Department of Corrections to conduct the criminal history check required for facility access. Individuals may obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee. The form includes staff documentation sections for recording the requesting staff member, the staff member conducting the check, clearance status (yes or no), and completion initials and date.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Specifications - Phase Two.pdf | ||
| Drawings-Phase Two.pdf | ||
| Addendum 1 Phase 2 16399.pdf | ||
| Advertisement - Phase Two.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 03/15
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 and your Social Security 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 at least two of the following three types of identification:
Driver’s License # State issued by
State ID # State issued by
Social Security #
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 Pavement Improvements - Phase Two File # 472/16399.JAG
File details come from the government source that posted it. Updated .