LEIN Request 19086.pdf
PDF 22 KB Posted
- Solicitation number
- RFP-171-190000003200-1
- Issued by
- Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Vendor/Contractor LEIN (Law Enforcement Information Network) Request Form (CAJ-1037) associated with the Michigan Reformatory Steam System Repairs/Replacement project (File #472/19086.DCS). The form is a required criminal background check authorization document that vendors and contractors must complete before being granted access to MDOC facilities. It requires personal identification information including name, address, date of birth, sex, race, and either a driver's license number or state ID number with the issuing state.
The form includes a section for staff use only, which documents the reason for the LEIN check, staff requesting and conducting the check, and whether the check was cleared. If the check is not cleared, applicants are directed to obtain a copy of their Michigan criminal history through www.michigan.gov/ichat for a fee. The form also includes an authorization statement that must be signed and dated by the applicant, allowing MDOC to conduct the criminal history check for facility access purposes.
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Other files
| File | Type | Posted |
|---|---|---|
| Project Statement 19086.pdf | ||
| RFP 19086.pdf | ||
| SAMPLE PSC Contract Billable Rate (Rev 1902).pdf |
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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 - Steam System Repairs / Replacement File # 472/19086.DCS
File details come from the government source that posted it. Updated .