LEIN Request 23105.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ 171 230000000251 2
- Issued by
- Cheboygan County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form CAJ-1037 issued by the Michigan Department of Corrections (MDOC) for the Carson City Correctional Facility Fence Modifications and Additions project (File #472/23105.TYC). The form is used to conduct criminal history checks for individuals seeking access to secure perimeters or properties of MDOC facilities to perform work, visit, or meet with MDOC offenders. The form collects personal identification information including driver's license or state identification card numbers, date of birth, race, and sex to complete the background check process. Requesters must indicate their affiliation category—whether they are HR personnel, contractors, visitors, volunteers, or representing an outside agency—and confirm whether they will be entering the secure perimeter of an MDOC facility.
The form requires the applicant's authorization for MDOC to conduct a criminal history check and, for HR/employment purposes, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The LEIN clearance determination (Yes/No) is documented by the completing official, with optional comments regarding conviction records. This document serves as an administrative screening tool rather than a pricing, funding, or contractual terms document, establishing security and personnel approval requirements for the Carson City facility project.
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Other files
| File | Type | Posted |
|---|---|---|
| Specifications 23105.pdf | ||
| Advertisement 23105.pdf | ||
| Addendum 1 23105.pdf | ||
| Drawings 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 .