LEIN Request 19537.pdf
PDF 174 KB Posted
- Solicitation number
- RFP 171 200000001281 4
- Issued by
- Alcona 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 criminal history verification purposes related to facility access and employment screening. The form is associated with the Alger Correctional facility Security Door Replacement project (File #472/19537.JBB). The document serves as the mechanism through which MDOC processes background checks for individuals requiring access to secure perimeters or properties at MDOC facilities, including employees, contractors, visitors, and volunteers. Requestors must provide personal identification information including driver's license or state identification number, date of birth, race, and sex to enable the criminal history check through the LEIN database.
The form indicates authorization for MDOC to conduct criminal history checks and, for HR/employment purposes, to review motor vehicle operator license records to determine eligibility for operating vehicles during Department business. Completion of the LEIN check is documented with clearance status noted as either approved or not cleared, with specific notation of conviction counts and optional comments. The form is completed by designated MDOC personnel and requires both applicant signature with date and completion date by the LEIN administrator.
View the file
Other files
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: Alger Correctional / Security Door Replacement File # 472/19537.JBB
File details come from the government source that posted it. Updated .