LEIN Request 18228.pdf

PDF 24 KB Posted

Attached to
472/18228. RMP; MI Reformatory - Bubble Sliding Gate
Solicitation number
RFQ 171 190000000218 2
Issued by
Huron County, Michigan

About this file

This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections for vendor and contractor criminal history clearance. The form is required for individuals seeking approval to visit or meet with persons confined in Michigan Department of Corrections facilities. The specific project referenced is the Michigan Reformatory - Bubble Sliding Gate and Controls Replacement (File #472/18228.RMP). Vendors and contractors must complete the form by providing personal identification information, including driver's license or state identification card number, date of birth, race, and sex, along with their professional classification and contact information. Authorization must be granted by the applicant's signature to allow MDOC to conduct the criminal history check before facility access can be approved.

The LEIN check is a mandatory clearance requirement with no pricing or contractual terms specified in this form, as it serves solely as a pre-qualification screening document rather than a contract solicitation. The form indicates that LEIN clearance must be completed and approved before the vendor or contractor can proceed with facility access. Staff use sections document the requesting party, the individual conducting the check, and clearance status (yes or no). Applicants may obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee if needed to resolve any clearance issues.

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Text version

MICHIGAN DEPARTMENT OF CORRECTIONS

VENDOR/CONTRACTOR LEIN REQUEST

CAJ-1037

REV. 04/18

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 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 one of the following types of identification:

Driver’s License # State issued by

State ID # State issued by

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: Michigan Reformatory - Buibble Sliding Gate and Controls Replacement File # 472/18228.RMP

File details come from the government source that posted it. Updated .