LEIN Request 23105.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ - 171 - 230000000251
- Issued by
- Ionia County, Capac Village, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) request form from the Michigan Department of Corrections (MDOC). The form is used to complete a criminal history check for individuals who need to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with, or work with MDOC offenders. The form requires the individual's personal information, such as name, address, date of birth, sex, race, and driver's license or state ID number. The individual must authorize the MDOC to conduct the criminal history check and, if for employment purposes, to check the individual's motor vehicle operator license record.
The related state and local contract opportunity is for the Carson City Correctional Facility's fence modifications and additions, identified as project number 472/23105.TYC. The project details note that all questions should be emailed to the project manager, and bid attachments must be uploaded to the SIGMA VSS system. The bid deadline is 2:00 p.m., and emailed submissions may be considered on a case-by-case basis. The project is located in Ionia County and the Village of Capac, Michigan.
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Other files
| File | Type | Posted |
|---|---|---|
| Advertisement 23105.pdf | ||
| Specifications 23105.pdf | ||
| Drawings 23105.pdf | ||
| Addendum 1 23105.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: Carson City CF - Fence Modifications and Additions File # 472/23105.TYC
File details come from the government source that posted it. Updated .