LEIN Request 19535.pdf
PDF 179 KB Posted
- Attached to
- 472/19535. MAA; Thumb CF - ADA Ramps
- Solicitation number
- RFQ - 171 - 220000000285
- Issued by
- Lapeer County, Lansing City, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC). It is used to conduct a criminal history check for individuals seeking to enter the secure perimeter or property of an MDOC facility, such as contractors, visitors, or volunteers. The form requires the individual's personal information, including name, address, date of birth, sex, race, and driver's license or state ID number. The individual must authorize the MDOC to conduct the criminal history check and, if applicable, a motor vehicle operator's license record check.
The related state and local contract opportunity is for the Thumb Correctional Facility - ADA Ramps project, identified as File #472/19535.MAA. The project location is in Lapeer County and Lansing City, Michigan. The bid submission process includes specific instructions, such as emailing questions to the designated contact, uploading bid attachments to SIGMA VSS, and potential COVID-19 precautions, such as wearing masks. The contract details, such as pricing terms, set-asides, incumbents, funding sources, and award dates, are not provided in this document.
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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: Thumb CF - ADA Ramps File # 472/19535.MAA
File details come from the government source that posted it. Updated .