LEIN Request 18412.pdf
PDF 165 KB Posted
- Attached to
- 472/18412; Brooks CF - Pole Building
- Solicitation number
- RFQ 171 200000000001 1
- Issued by
- Mackinac County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form CAJ-1037 from the Michigan Department of Corrections (MDOC) used to conduct criminal history checks for individuals requiring access to MDOC facilities. The form is associated with the Earnest C. Brooks Correctional Facility Pole Building project (File #472/18412.GAG). The document serves as a standardized request mechanism for vetting employment candidates, human resources personnel, contractors, visitors, volunteers, and other individuals who need to enter the secure perimeter or property of MDOC facilities to perform work, conduct visits, or interact with MDOC offenders.
The form requires submission of personal identification information including driver's license or state identification card number, date of birth, race, and sex to facilitate the criminal history background check. Authorization is required from the subject individual to allow MDOC to conduct the criminal history check and, for employment purposes only, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The form includes fields for completion by LEIN personnel, clearance status notation, and optional comments regarding conviction history for MDOC employment or human resources purposes.
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Other files
| File | Type | Posted |
|---|---|---|
| Plans 2 of 4 18412.pdf | ||
| Plans 1 of 4 18412.pdf | ||
| Advertisement 18412.pdf | ||
| Specifications 18412 (s).pdf | ||
| Plans 4 of 4 18412.pdf | ||
| Plans 3 of 4 18412.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
LEIN REQUEST
CAJ-1037.
REV. 09/19.
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, date-of-birth, race and sex is needed to complete this LEIN request.
Employment/Human Resources HR Personnel / Requesting
Contractor Visitor Contractor Agency Agency Representing
Volunteer Other Agency Representing Agency Representing Are you entering the secure perimeter/property of a Michigan Department of Corrections (MDOC) facility? Yes No
Please print information below:
Last Name: 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 MDOC to conduct a criminal history check, so that I may be approved to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with or work with MDOC offenders.
For MDOC HR/Employment purposes only: I further authorize the Department to check my motor vehicle operator license record for the purposes of determining if I will be allowed to operate a motor vehicle while conducting Department business.
Signature: Date:
LEIN Completed By: Name: Date:
LEIN Cleared: Yes No (Does not apply to Human Resources)
MDOC Employment/HR purposes: Indicate the # of convictions:
Comment (Optional):
hallt2 Text Box Facility/Project Name: Earnest C. Brooks Correctional Facility - Pole Building
File # 472/18412.GAG
File details come from the government source that posted it. Updated .