LEIN Request 16402.pdf
PDF 35 KB Posted
- Solicitation number
- RFQ-171-180000000714-2
- Issued by
- Oakland County, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Vendor/Contractor LEIN (Law Enforcement Information Network) Request form (CAJ-1037) associated with the E.C. Brooks Correctional Facility Propane Plant Replace/repair Back-up Fuel System project (File #472/16402.TYC). The form is used to conduct criminal history background checks for vendors and contractors who need to access MDOC facilities. The document requires individuals to provide personal identification information including driver's license or state ID number, date of birth, race, and sex.
The form includes sections for basic personal information, professional designation (vendor or contractor), and authorization for MDOC to conduct the criminal background check. There is also a "Staff Use Only" section at the bottom for LEIN check processing. If the LEIN check is not cleared, individuals can obtain a copy of their Michigan criminal history through www.michigan.gov/ichat for a fee.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| EC Br Propane 1.JPG | JPG image | |
| Addendum 1.pdf | ||
| DTMB-0415 (Design Build Advertisement R10-17).pdf | ||
| EC Br Propane 3.JPG | JPG image | |
| EC Br Propane 4.JPG | JPG image | |
| Design Build Master (10-27-17).pdf | ||
| EC Br Propane 2.JPG | JPG image |
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
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 04/18
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 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 one of the following types of identification:
Driver’s License # State issued by
State ID # State issued by
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: E.C. Brooks Correctional Facility, Propane Plant Replace/repair Back-up Fuel System File # 472/16402.TYC
File details come from the government source that posted it. Updated .