LEIN Request 17032 St Louis.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ-171-250000000456-2
- Issued by
- Gogebic County, Michigan
About this file
The document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC), specifically associated with the St. Louis Correctional Facility WiFi Cabling Infrastructure project (File #472/17032.RWG). This form is designed for individuals seeking to enter a secure MDOC facility perimeter, requiring a criminal history check as part of the access authorization process. The form is used to collect personal identification details such as driver's license or state ID number, date of birth, race, and sex to facilitate a comprehensive background screening.
The LEIN Request serves as a standard procedural document for contractors, visitors, volunteers, or other personnel who need to access MDOC facilities. By completing and signing the form, the individual authorizes the MDOC to conduct a criminal history check and, for employment purposes, to review their motor vehicle operator license record. The form includes checkboxes for different categories of personnel and requires the individual to indicate whether they will be entering the secure facility perimeter. The document is part of the MDOC's standard security protocol for managing access to correctional facilities, ensuring that only individuals who pass a background check are permitted entry.
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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: St Louis CF - WiFi Cabling Infrastructure File # 472/17032.RWG
File details come from the government source that posted it. Updated .