LEIN Request 17466.pdf
PDF 43 KB Posted
- Attached to
- 472/17466. CDP Lakeland CF - Storm Water System
- Solicitation number
- RFP-171-180000000957-2
- Issued by
- Barry County, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Vendor/Contractor LEIN Request form (CAJ-1037) associated with the LCF Sanitary Sewer Improvements project (File #472/17466.CDP). The form is used to conduct criminal history background checks through the Michigan Law Enforcement Information Network (LEIN) for vendors and contractors who need access to MDOC facilities. The document requires personal identification information including name, address, date of birth, sex, race, and at least two forms of identification from the following: driver's license number, state ID number, or Social Security number.
The form includes a section for staff use only, which tracks the reason for the LEIN check, requesting staff information, and the results of the check (clear/not clear). If the check returns negative results, applicants can obtain their Michigan criminal history through www.michigan.gov/ichat for a fee. The form requires the applicant's signature authorizing MDOC to conduct the criminal history check for facility access purposes.
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Other files
| File | Type | Posted |
|---|---|---|
| PreProposal SignIn 17466.pdf | ||
| 2017 Force Main Plans 17466.pdf | ||
| 1970 Force Main Plans (1 MB) 17466.pdf | ||
| ProjectStatement 17466.pdf | ||
| RFP 17466.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: LCF Sanitary Sewer Improvements File #: 472/17466.CDP (T.L.)
File details come from the government source that posted it. Updated .