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
- Kalamazoo County, Michigan
About this file
This is a Michigan Department of Corrections vendor and contractor LEIN (Law Enforcement Information Network) request form used to conduct criminal history checks for individuals seeking access to MDOC facilities. The form is associated with the Egeler Reception and Guidance Center Fire Alarm Project (File #472/17129.RMP) and requires vendors and contractors to submit personal identification information including driver's license number or state identification card number, social security number, date of birth, race, and sex. The form authorizes MDOC to perform criminal background checks as a prerequisite for facility access and approval to meet with confined individuals. Completion and clearance of the LEIN check is mandatory before potential entry into MDOC facilities is permitted.
The form requests at least two of three types of identification documentation (driver's license, state ID, or social security number) to facilitate the background check process. Individuals can obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee. The form includes space for staff use only sections documenting who requested the LEIN check, who completed it, and the clearance status (yes or no), with corresponding initials and dates recorded by MDOC personnel.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1 17129.pdf | ||
| PreBid Sign In Sheet.pdf | ||
| Advertisement 17129.pdf | ||
| Addendum 2 17129.pdf | ||
| DCSpec 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 .