LEIN Request 19527.pdf
PDF 174 KB Posted
- Solicitation number
- RFQ 171 260000000310 2
- Issued by
- Huron County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request Form issued by the Michigan Department of Corrections (MDOC) for the Bellamy Creek Correctional Facility ADA Egress Ramps project (File #472/19527.SMD). The form is used to conduct criminal history checks for individuals requiring access to the secure perimeter or property of MDOC facilities. The requestor must provide personal identification information including driver's license or state identification number, date of birth, race, and sex. The form applies to various categories of individuals including employment candidates, contractors, visitors, volunteers, and agency representatives who need approval to enter MDOC secure areas to perform work, conduct visits, or interact with offenders.
The form authorizes MDOC to perform a criminal history check as a condition of access approval to the facility. For employment and human resources purposes, MDOC may also review motor vehicle operator license records to determine eligibility for operating vehicles while conducting departmental business. The requesting form requires completion by MDOC personnel or the requesting contractor, with signature and date authorization from the applicant. MDOC then verifies clearance status, and for employment purposes, documents the number of convictions and any relevant comments. This criminal background screening is a mandatory prerequisite for any individual seeking to work on or access the Bellamy Creek Correctional Facility project.
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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: Bellamy Creek C.F. - ADA Egress Ramps File # 472/19527.SMD
File details come from the government source that posted it. Updated .