LEIN Request 23108.pdf
PDF 123 KB Posted
- Solicitation number
- RFP 171 230000001319 2
- Issued by
- Benzie 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 background check authorization. The form is associated with the Lakeland Correctional Facility Housing Unit B1 Conversion to ADA Accessible Unit project (File #472/23108.TYC). The document serves as the standard authorization document required for any individual—including employment candidates, contractors, visitors, volunteers, or other representatives—who needs to enter the secure perimeter or property of an MDOC facility to perform work, conduct visits, meet with MDOC personnel, or work with offenders. The form requires collection of personal identification information including driver's license or state ID number, date of birth, race, sex, and full name and address details to complete the criminal history background check through the Michigan Law Enforcement Information Network.
The LEIN Request Form CAJ-1037 (Revised 09/19) contains no pricing information, set-asides, funding requirements, or contract award details, as it is a prerequisite screening and authorization document rather than a procurement or contract document. The form indicates that MDOC HR or employment personnel complete the LEIN check and determine clearance status, with an additional authorization option for motor vehicle operator license record checks for those who will operate vehicles while conducting Department business. This authorization form is mandatory administrative documentation required before any contractor or vendor personnel can be granted facility access for the Housing Unit B1 conversion project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| SAMPLE Billable Rate Contract (Rev 220207).pdf | ||
| Project Statement 23108.pdf | ||
| RFP Addendum 1.pdf | ||
| RFP Billable Rate 23108.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: Lakeland CF - Housing Unit B1 Conversion to ADA Accessible Unit File # 472/23108.TYC
File details come from the government source that posted it. Updated .