LEIN Request 19043 - 2020.pdf
PDF 160 KB Posted
- Solicitation number
- RFQ 171 200000000134 2
- Issued by
- Macomb County, Sterling Village, Michigan
About this file
This is a Criminal History Check Request Form (LEIN Request 19043) from the Michigan Department of Corrections (MDOC) for the Central Michigan Correctional Facility Door and Window Replacement project (File #472/19043.JAG). The form is used to conduct background checks through the Michigan Law Enforcement Information Network (LEIN) for individuals seeking access to secure perimeters or properties at MDOC facilities. The request pertains to employment, human resources, contractor, visitor, volunteer, or other agency personnel who need approval to enter secure areas to perform work, conduct visits, meet with, or work 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 complete the background check process.
The form authorizes MDOC to conduct a comprehensive criminal history check and, for HR/employment purposes only, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. Requestors must sign and date the authorization, and MDOC personnel complete the LEIN check, documenting clearance status and noting the number of convictions if applicable. This background clearance requirement applies to all personnel accessing secure MDOC facilities regardless of their role or affiliation with the organization.
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Other files
| File | Type | Posted |
|---|---|---|
| 19043 Specifications_Bid Set.pdf | ||
| 19043 Addendum 1 - 2.13.2020 package.pdf | ||
| 19043 Advertisement.pdf | ||
| 19043 Drawings_Bid Set.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: Central Michigan CF - Door and Window Replacement File # 472/19043.JAG
File details come from the government source that posted it. Updated .