LEIN Request 17396 Bid Pack 3A.pdf
PDF 31 KB Posted
- Solicitation number
- RFQ 171 180000000556 2
- Issued by
- Macomb County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC) for Bid Pack 3A related to Project File #472/17396.SMD, designated as the Various CF - Razor Ribbon Project. The form is required for vendors and contractors who need to access Michigan Department of Corrections facilities. Potential entry into MDOC facilities requires completion and clearance of a LEIN criminal history check. The form requests vendor or contractor information including name, address, date of birth, sex, and race. Additionally, applicants must provide identification documentation in the form of at least two of the following: a driver's license number, state-issued identification card number, or Social Security number.
Applicants authorize MDOC to conduct a criminal history check through the LEIN system to determine approval for visiting or meeting with confined persons in MDOC facilities. The form includes space for staff use only, documenting the reason for the LEIN check, the staff member requesting it, and the date of completion. Individuals may obtain a copy of their Michigan criminal history through www.michigan.gov/ichat for a fee. This LEIN clearance is a prerequisite administrative requirement for any vendor or contractor participation in this project and must be completed prior to facility access.
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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: Various CF - Razor Ribbon Project File # 472/17396.SMD
File details come from the government source that posted it. Updated .