LEIN Request 19480.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ-171-240000000710-3
- Issued by
- Arenac County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC). The form is used to request a criminal history check for individuals seeking to enter the secure perimeter/property of an MDOC facility to perform work, visit, or meet with MDOC offenders. The form requires the individual's personal information such as name, address, date of birth, sex, race, and driver's license or state ID number. The individual is required to authorize the MDOC to conduct the criminal history check and, for MDOC employment/HR purposes, to check the individual's motor vehicle operator license record.
The document also includes the Facility/Project Name as "Baraga Correctional Facility Unit 1 Basketball Court" and the File # as 472/19480.TAP, which suggests this LEIN Request is related to a specific state or local contract opportunity. However, the document does not provide any further details about the contract opportunity, such as the scope of work, project description, or response requirements.
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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: Baraga Correctional Facility Unit 1 Basketball Court File # 472/19480.TAP
File details come from the government source that posted it. Updated .