LEIN Request 22301.pdf
PDF 123 KB Posted
- Solicitation number
- RFP 171 240000000559 3
- Issued by
- Arenac County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history clearance related to the Baraga Correctional Facility Sallyport Gate Upgrades project (File #472/22301.TAP). The form is used to authorize MDOC to conduct criminal history checks on individuals requiring access to secure perimeters or properties of MDOC facilities for employment, contracting, visiting, volunteering, or other authorized purposes. The document collects personal identification information including driver's license or state identification number, date of birth, race, and sex necessary to complete the background check through Michigan's Law Enforcement Information Network.
The form serves as authorization for MDOC to access motor vehicle operator license records for employment-related purposes and to determine eligibility for individuals to operate vehicles while conducting Department business. Requesters must indicate whether they are entering the secure perimeter of an MDOC facility and identify their capacity, such as HR personnel, contractor, visitor, volunteer, or other agency representative. Upon completion, MDOC personnel document whether the LEIN clearance was approved or denied, with optional notation of conviction records and comments. This administrative document is a prerequisite requirement for participation in facility-related projects and contractor work.
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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: Baraga CF - Sallyport Gate Upgrades File # 472/22301.TAP
File details come from the government source that posted it. Updated .