LEIN Request 19320.pdf

This is a LEIN Request Form (CAJ-1037, Revised 09/19) issued by the Michigan Department of Corrections (MDOC) for criminal history background checks required for facility access. The form is associated with the Alger Correctional Facility Shower Renovations project (File #472/19320.JBB). The LEIN (Michigan Law Enforcement Information Network) request is used to screen individuals—including employment candidates, contractors, visitors, and volunteers—who require approval to enter the secure perimeter or property of MDOC facilities to perform work, conduct visits, or interact with offenders. The form collects personal identification information including driver's license or state identification card number, date of birth, race, and sex, along with standard demographic data required to complete the criminal history background check process.

The form authorizes MDOC to conduct comprehensive criminal background checks and, for HR/employment purposes, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The requesting entity must identify their role (HR personnel, contractor, visitor, volunteer, or other representative) and indicate whether they will be entering the secure perimeter. The form includes fields for documenting the number of convictions and optional comments, with a signature line for applicant authorization and separate sections for MDOC personnel to complete the LEIN check and indicate clearance status. This form serves as the preliminary documentation step in the contractor and personnel vetting process for the Alger facility renovation project.