LEIN Request 23129.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ-171-250000000303-4
- Issued by
- Livingston County, Michigan
About this file
The document is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for conducting criminal history checks. The form is designed for contractors, visitors, volunteers, or other individuals seeking to enter the secure perimeter or property of an MDOC facility. It requires detailed personal identification information including full name, address, date of birth, sex, race, and either a driver's license or state identification number.
The form authorizes MDOC to perform a comprehensive background check for facility access purposes, with additional authorization for MDOC Human Resources to review motor vehicle operator records if the individual may operate a vehicle while conducting department business. The form includes sections for MDOC personnel to complete the LEIN check, indicate clearance status, and record the number of convictions, if applicable. By signing the document, the individual provides consent for the criminal history investigation as a prerequisite for entering MDOC facilities or engaging with MDOC offenders.
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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 .