LEIN Request 19320.pdf
PDF 174 KB Posted
- Attached to
- 472/19320. JBB; Alger C. F. - Shower Renovations
- Solicitation number
- RFQ-171-250000000316-2
- Issued by
- Alger County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC), specifically associated with the Alger C.F. - Shower Renovations project (File #472/19320.JBB). The form is designed to conduct a criminal history check for individuals seeking to enter a secure MDOC facility, whether as an employee, contractor, volunteer, or visitor. The form requires detailed personal identification information, including name, address, date of birth, race, sex, and either a driver's license or state ID number.
The purpose of this document is to facilitate a comprehensive background screening process for individuals who may interact with MDOC offenders or enter secure correctional facility perimeters. By completing this form, the individual authorizes the MDOC to perform a criminal history check and, for employment purposes, to review their motor vehicle operator license record. The form includes checkboxes for various entry purposes and provides spaces for MDOC personnel to record the results of the LEIN check, including whether the individual is cleared and the number of any convictions.
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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: Alger C.F. - Shower Renovations File # 472/19320.JBB
File details come from the government source that posted it. Updated .