LEIN Request 23129.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ-171-250000000303-3
- Issued by
- Kalamazoo County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) for the Woodland CF - Utility Improvements project (File #472/23129.SDW). The form is designed to conduct criminal history checks for individuals seeking to enter secure perimeter/property of an MDOC facility, including contractors, visitors, volunteers, and other personnel. The form requires detailed personal identification information such as name, address, date of birth, race, sex, and either a driver's license or state ID number.
The LEIN Request serves as an authorization for the MDOC to perform comprehensive background checks, with specific provisions for employment/HR purposes that include checking motor vehicle operator license records. The form allows the department to verify an individual's eligibility to work, visit, or interact with MDOC offenders by screening for criminal history. The document is specifically associated with the Woodland Correctional Facility's utility improvements project, suggesting that individuals filling out this form are likely contractors or personnel involved in the facility's infrastructure upgrade work.
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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 .