LEIN Request 17032.pdf
PDF 179 KB Posted
- Solicitation number
- RFQ 171 250000000125 2
- Issued by
- Alger County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history background checks. The form is associated with the Alger Correctional Facility Wi-Fi Infrastructure Cabling project, referenced as File #472/17032.RWG. The LEIN request is a standard screening requirement for individuals seeking access to secure perimeters or properties at MDOC facilities, whether for employment, contract work, visitation, or volunteer purposes. Requestors must provide personal identification information including driver's license or state identification number, date of birth, race, and sex to enable the criminal history check through the LEIN database.
The form authorizes MDOC to conduct criminal history background checks as a prerequisite for facility access and work authorization. For MDOC HR and employment purposes, the Department may additionally review motor vehicle operator license records to determine eligibility for operating vehicles during Department business. The form includes fields for documenting the number of convictions and optional comments regarding the clearance determination. Completion and clearance of the LEIN request are documented by MDOC personnel through signature and date fields on the form.
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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: Alger C.F. - Wi-Fi Infrastructure Cabling File # 472/17032.RWG
File details come from the government source that posted it. Updated .