LEIN Request 19503.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ 171 230000000791 2
- Issued by
- Barry County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) for conducting criminal history checks on individuals requiring access to secure facilities. The form is associated with the Lakeland Correctional Facility (SRF) Building 29 HVAC Upgrades project (File #472/19503.SMD). The document serves as a standardized request template used to collect personal information—including name, date of birth, race, sex, and identification details—from employment and human resources personnel, contractors, visitors, volunteers, and other individuals seeking to enter the secure perimeter or property of MDOC facilities to perform work, conduct visits, meet with officials, or work with offenders.
The LEIN request form requires applicants to authorize the MDOC to conduct criminal history checks through the Michigan Law Enforcement Information Network and, for employment purposes, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The form includes fields for completion by MDOC personnel to document whether the LEIN check was completed and cleared, along with optional comments regarding conviction counts for employment screening purposes. This administrative tool is essential for facility security protocols and personnel vetting procedures related to the Building 29 HVAC Upgrades project at Lakeland Correctional Facility.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: Lakeland CF (SRF) – Building 29 HVAC Upgrades File # 472/19503.SMD
File details come from the government source that posted it. Updated .