LEIN Request 23025.pdf
PDF 174 KB Posted
- Solicitation number
- RFQ 171 250000000362 4
- Issued by
- Baraga County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history clearance purposes. The form is associated with the Baraga Correctional Facility Shower Upgrades Project (File #472/23025.TAP) and is used to screen individuals requiring access to MDOC secure facilities. The form collects personal identification information including name, date of birth, address, sex, and race, along with driver's license or state identification details. Requesters must authorize the MDOC to conduct criminal history checks to gain approval for entering secure perimeters to perform work, visit, or conduct business with MDOC offenders. For MDOC employment and human resources purposes, the form also authorizes motor vehicle operator license record checks to determine eligibility for operating vehicles during Department business.
The form is designated for use by HR personnel, contractors, visitors, volunteers, and agency representatives seeking facility access. The LEIN clearance section includes fields for documenting whether the check was completed and cleared, conviction counts, and optional comments. This screening mechanism serves as a standard security protocol for the Baraga Correctional Facility infrastructure project, ensuring that all personnel entering secure areas have undergone appropriate background verification before authorization is granted.
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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 - Shower Upgrades Project File # 472/23025.TAP
File details come from the government source that posted it. Updated .