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 LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC) for vendor and contractor criminal history clearance. The request is associated with a project at E.C. Brooks Correctional Facility involving propane plant replacement and repair of the back-up fuel system (File #472/16402.TYC). The form is used to process criminal background checks required for vendors and contractors seeking approval to enter MDOC facilities. Required information includes the applicant's full name, address, date of birth, sex, race, and a valid driver's license number or state identification card number. Completion and clearance of the LEIN check is mandatory before any vendor or contractor may visit or meet with confined individuals at Michigan Department of Corrections facilities.
The form indicates that applicants may obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee. Once the LEIN check is completed, staff members conducting the check document clearance status, with options for approval (Yes) or denial (No). The form was revised in April 2018 (CAJ-1037 REV. 04/18) and includes a signature line for applicant authorization of the background check process. This administrative requirement represents a prerequisite step in the vendor qualification process for the propane plant project at the E.C. Brooks facility.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| EC Br Propane 2.JPG | JPG image | |
| DTMB-0415 (Design Build Advertisement R10-17).pdf | ||
| Addendum 1.pdf | ||
| EC Br Propane 4.JPG | JPG image | |
| EC Br Propane 1.JPG | JPG image | |
| EC Br Propane 3.JPG | JPG image | |
| Design Build Master (10-27-17).pdf |
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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 .