LEIN Request 19532.pdf
PDF 159 KB Posted
- Solicitation number
- RFQ-171-250000000539-2
- Issued by
- Macomb County, Mcbride Village, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC), specifically for the Oaks Correctional Facility, related to ADA Egress Ramps and Infrastructure Improvements (File #472/18532.RLO). The form is designed to collect personal information and authorize a criminal history check for individuals who may need to enter a secure MDOC facility perimeter, such as contractors, visitors, volunteers, or other personnel.
The form requires detailed personal identification information including name, address, date of birth, sex, race, and either a driver's license or state ID number. By signing the document, the individual authorizes MDOC to conduct a comprehensive criminal history check and, for employment purposes, allows the department to review their motor vehicle operator license record. The form is structured to support background screening processes for individuals who may interact with or work in close proximity to MDOC offenders, ensuring facility security and personnel vetting.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 472_19532_RLO Addendum 1.pdf | ||
| Plans_19532.pdf | ||
| Advertisement 19532.pdf | ||
| Service Disabled Veteran Owned Business Info Sheet 2025.pdf | ||
| Specifications_19532.pdf |
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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: Oaks Correctional Facility - ADA Egress Ramps and Infrastructure Improvements
File # 472/18532.RLO
File details come from the government source that posted it. Updated .