LEIN Request 23129.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ-171-250000000303-2
- Issued by
- Livingston County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC) specifically associated with the Woodland CF - Utility Improvements project (File #472/23129.SDW). The form is designed to facilitate a criminal history background check for individuals seeking to enter a secure MDOC facility perimeter or property, such as contractors, visitors, volunteers, or other personnel. The form requires detailed personal identification information including full name, address, date of birth, race, sex, and either a driver's license or state identification number.
The form authorizes the MDOC to conduct a comprehensive criminal history check and, for employment purposes, review the individual's motor vehicle operator license record. The background check is part of the screening process for individuals who may work, visit, or interact with MDOC offenders. The form includes sections for MDOC personnel to complete the LEIN process, indicating whether the criminal history check is cleared and noting any convictions. The document is specifically linked to the Woodland Correctional Facility's utility improvements project, suggesting this is part of the pre-qualification process for contractors or personnel involved in that specific infrastructure project.
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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: Woodland CF - Utility Improvements File # 472/23129.SDW
File details come from the government source that posted it. Updated .