LEIN Request 17032 Lakeland C.F..pdf
PDF 174 KB Posted
- Solicitation number
- RFQ 171 250000000427 2
- Issued by
- Benzie County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) request form from the Michigan Department of Corrections (MDOC) used to conduct criminal history checks for individuals seeking access to secure facilities. The form is associated with the Lakeland Correctional Facility Wi-Fi Cabling/Infrastructure project (File #472/17032.RWG). The LEIN request collects personal identifying information including driver's license or state identification number, date of birth, race, and sex to complete background screening. The form accommodates various visitor categories including employment and human resources personnel, contractors, visitors, volunteers, and agency representatives requiring access to MDOC secure perimeters or property.
The form authorizes MDOC to conduct criminal history checks and, for HR/employment purposes, permits motor vehicle operator license record reviews to determine eligibility for operating vehicles during Department business. Completed LEIN requests are verified and marked as cleared or not cleared, with space provided for conviction counts and optional comments. This administrative document serves as a prerequisite screening tool for the Lakeland Correctional Facility infrastructure project, ensuring individuals working on or accessing the facility meet security clearance requirements established by MDOC.
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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: Lakeland C.F. - Wi-Fi Cabling /Infrastucture
File # 472/17032.RWG
File details come from the government source that posted it. Updated .