LEIN Request 19480.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ 171 240000000710 3
- Issued by
- Arenac County, Michigan
About this file
This is a Criminal History Check Request Form (LEIN Request CAJ-1037) issued by the Michigan Department of Corrections (MDOC) for personnel seeking access to secure facilities. The form is used to initiate a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for employees, contractors, visitors, volunteers, and other individuals requiring entry to MDOC secure perimeters or facilities. The specific project referenced is Unit 1 Basketball Court at Baraga Correctional Facility (File #472/19480.TAP). The form requires personal identification information including driver's license or state identification number, date of birth, race, and sex to complete the background check process.
The form authorizes MDOC to conduct criminal history checks and, for employment purposes, permits review of motor vehicle operator license records to determine eligibility to operate vehicles during department business. Completion of the LEIN check is mandatory for approval to enter secure facility areas. The form includes fields for documenting the number of convictions and optional comments by MDOC HR personnel. There are no pricing terms, contract awards, or renewal options associated with this administrative document, as it serves solely as a prerequisite screening mechanism for facility access rather than as a procurement or contract award instrument.
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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 .