LEIN Request 22301.pdf
PDF 123 KB Posted
- Solicitation number
- RFP 171 230000002241 2
- Issued by
- Arenac County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request Form CAJ-1037 issued by the Michigan Department of Corrections (MDOC) for criminal history clearance purposes related to the Baraga Correctional Facility Sallyport Gate Upgrades project (File #472/22301.TAP). The form is designed to collect personal identification information and authorization from individuals seeking access to secure perimeters or facilities operated by MDOC. The document requests standard demographic data including driver's license or state identification number, date of birth, race, and sex from applicants who may be employed, contracted, volunteering, or visiting MDOC facilities. Applicants must indicate whether they are entering the secure perimeter or property of an MDOC facility and provide authorization for the Department to conduct a criminal history check through LEIN as a condition of approval to perform work, visit, or interact with MDOC offenders.
The form serves dual purposes for MDOC HR and employment verification, with an optional secondary authorization allowing the Department to review motor vehicle operator license records to determine eligibility for operating vehicles during Department business. The LEIN clearance section includes fields for completion and approval status, with an optional comment field for HR purposes to document the number of convictions if applicable. The form requires signatures from both the applicant and LEIN personnel, with corresponding completion and clearance dates. This document is a standard security screening prerequisite rather than a procurement or contract award notice.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP Billable Rate 22301.pdf | ||
| SAMPLE Billable Rate Contract (Rev 221207).pdf | ||
| Project Statement with attachmts 22301.pdf | ||
| 22301 PreProp Attendance.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: Baraga Correctional Facility - Sallyport Gate Upgrades File # 472/22301.TAP
File details come from the government source that posted it. Updated .