LEIN Request 21357.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ - 171 - 230000000304
- Issued by
- Ionia County, Michigan
About this file
This document is a LEIN Request Form from the Michigan Department of Corrections (MDOC). It is used to request a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for individuals who need to enter the secure perimeter or property of an MDOC facility to perform work, visit, meet with, or work with MDOC offenders. The form collects the individual's personal information, including their name, address, date of birth, sex, race, and driver's license or state identification number. The individual must authorize the MDOC to conduct the criminal history check and, if applicable, check their motor vehicle operator's license record. The LEIN Request Form is related to the Michigan Reformatory - Building Demolitions contract opportunity, identified as File #472/21357.SMD. This project involves building demolitions at the Michigan Reformatory and is located in Ionia County, Michigan.
The contract opportunity requires bidders to upload their attachments to the SIGMA VSS system, and they are instructed not to submit questions online via VSS but to email them to the designated contact, Richard Mann. Bidders are also advised to notify the Office of Design and Construction if they experience issues with the SIGMA VSS system, and they may be asked to email their proposal, which will be handled on a case-by-case basis.
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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: _Michigan Reformatory - Building Demolitions File # 472/21357.SMD
File details come from the government source that posted it. Updated .