LEIN Request 23158.pdf
PDF 165 KB Posted
- Solicitation number
- RFQ 171 260000000476 3
- Issued by
- Michigan
About this file
This document is a LEIN Request Form (CAJ-1037) issued by the Michigan Department of Corrections (MDOC) for the Carson City Correctional Facility - Cell Door Locks and Controls Upgrades project (File #472/23158.TYC). The form is used to initiate criminal history background checks through the Michigan Law Enforcement Information Network (LEIN) for individuals requiring access to secure perimeters or properties at MDOC facilities. The form applies to employment candidates, contractors, visitors, volunteers, and other individuals who need approval to enter secure areas to perform work, conduct visits, or interact with MDOC offenders.
The form collects personal identification information including full name, date of birth, sex, race, address, and valid identification numbers (driver's license or state ID). Applicants must authorize the MDOC to conduct criminal history checks and, for employment or HR purposes, authorize checks of motor vehicle operator license records. The form requires signature and date from the applicant and includes sections for MDOC personnel to document LEIN completion status, clearance determination (Yes/No), conviction counts, and optional comments. This administrative document serves as a prerequisite screening tool rather than a contract or procurement document itself.
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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 Correctional Facility - Cell Door Locks and Controls Upgrades File # 472/23158.TYC
File details come from the government source that posted it. Updated .