LEIN Request 17129.pdf
PDF 25 KB Posted
- Attached to
- Egeler CF - Fire Alarm Project 472/17129. RMP
- Solicitation number
- RFQ-171-180000000915-4
- Issued by
- Michigan
About this file
The document is a Vendor/Contractor Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC), specifically for the Egeler Reception and Guidance Center's Fire Alarm Project (File #472/17129.RMP). The form is designed to conduct a criminal history check for vendors or contractors seeking to enter MDOC facilities, requiring detailed personal identification information including driver's license or state ID, social security number, date of birth, race, and sex.
The form requires the individual to provide authorization for a criminal background check through the Michigan Law Enforcement Information Network as a prerequisite for facility access. The MDOC will use this information to verify the individual's eligibility to visit or meet with persons confined in a corrections facility. The form includes a section for staff to record the LEIN check results, with an option to obtain a copy of the Michigan criminal history online for a fee if the initial check does not clear.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1 17129.pdf | ||
| DCSpec 17129.pdf | ||
| Advertisement 17129.pdf | ||
| PreBid Sign In Sheet.pdf | ||
| Addendum 2 17129.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 03/15
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 and your Social Security 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 at least two of the following three types of identification:
Driver’s License # State issued by
State ID # State issued by
Social Security #
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: Egeler Reception and Guidance Center - Fire Alarm Project File # 472/17129.RMP
File details come from the government source that posted it. Updated .