LEIN Request 16345.pdf
PDF 24 KB Posted
- Attached to
- 472/16345. TAP Chippewa CF - Freezer Replacement
- Solicitation number
- RFQ-171-180000000363-2
- Issued by
- Lake County, Michigan
About this file
This is a Vendor/Contractor LEIN (Law Enforcement Information Network) Request form (CAJ-1037) from the Michigan Department of Corrections for the Chippewa Correctional Facility Food Service Freezer Replacement project (File #472/16345.TAP). The form is used to conduct criminal history checks for vendors and contractors who need access to MDOC facilities. It requires potential contractors to provide personal identification information including driver's license or state ID number, social security number, date of birth, race, and sex.
The form includes sections for the applicant's profession (vendor or contractor), personal information, and at least two forms of identification from three options: driver's license, state ID, or social security number. The document includes a staff-use-only section for recording the reason for the LEIN check, staff requesting the check, who performed the check, and whether the check was cleared. If the check is not cleared, applicants are directed to obtain their Michigan criminal history at www.michigan.gov/ichat for a fee.
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Other files
| File | Type | Posted |
|---|---|---|
| Plans 16345.pdf | ||
| Addendum 1.pdf | ||
| Specifications 16345.pdf | ||
| Advertisement 16345.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: Chippewa Correctional Facility - Food Service Freezer Replacement File # 472/16345.TAP
File details come from the government source that posted it. Updated .