LEIN Form 22327.pdf
PDF 160 KB Posted
- Attached to
- 472/22327. MAA; Thumb CF - Gun Range Development
- Solicitation number
- RFQ - 171 - 230000000137
- Issued by
- Lapeer County, Lansing City, Michigan
About this file
The document is a LEIN Request Form from the Michigan Department of Corrections (MDOC) to conduct a criminal history check for an individual who is seeking approval to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with or work with MDOC offenders. The form requests the individual's personal information, including their name, address, date of birth, sex, race, and driver's license or state ID number. The individual authorizes the MDOC to conduct the criminal history check and, for MDOC employment/HR purposes, to check their motor vehicle operator license record.
The related state and local contract opportunity is for the Thumb CF - Gun Range Development project, which is located in Lapeer County, Michigan and the City of Lansing. The project details, response dates, due dates, and other salient information are not provided in the given document.
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Other files
| File | Type | Posted |
|---|---|---|
| Advertisement 22327.pdf | ||
| Plans 22327.pdf | ||
| Specifications 22327.pdf | ||
| Addendum 1 22327.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 Facility/Project Name: Thumb CF - Gun Range Development File # 472/22327.MAA
File details come from the government source that posted it. Updated .