LEIN form 21301.pdf
PDF 194 KB Posted
- Solicitation number
- RFQ 171 220000000305 3
- Issued by
- Arenac County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form from the Michigan Department of Corrections (MDOC) used to conduct criminal history checks for individuals seeking access to secure MDOC facilities. The form is associated with the Baraga Correctional Video Management System Upgrade - Phase 1 project (File #472/21301.JBB). The document serves as a prerequisite authorization tool rather than a procurement solicitation, requiring individuals to provide personal identification information including driver's license or state ID number, date of birth, race, and sex to complete the background check process. The form applies to various categories of individuals including HR personnel, contractors, visitors, volunteers, and agency representatives who need to enter the secure perimeter or property of an MDOC facility to perform work, conduct visits, or interact with MDOC offenders.
The LEIN form includes authorization language permitting MDOC to conduct criminal history checks and, for employment purposes only, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. Completed forms are submitted to smithD76@michigan.gov with an optional comment field for conviction information. The form requires the requesting party's signature and date, with LEIN completion and clearance documentation to be completed by MDOC personnel. This administrative form does not contain pricing, funding information, or contract terms, as it functions as a security clearance prerequisite document rather than a bid solicitation or contract award notice.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Plans 3 of 4 21301.pdf | ||
| Plans 4 of 4 21301.pdf | ||
| Addendum 1 21301.pdf | ||
| Addendum 2 21301.pdf | ||
| Plans 2 of 4 21301.pdf | ||
| Specification 21301.pdf | ||
| Plans 1 of 4 21301.pdf | ||
| Advertisement 21301.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):
Email to: smithD76@michigan.gov hallt2 Text Box Facility/Project Name: Baraga Correctional Video Management Sytem Upgrade - Phase 1..
File # 472/21301.JBB
File details come from the government source that posted it. Updated .