LEIN Request 23287.pdf
PDF 123 KB Posted
- Solicitation number
- RFP 171 230000002185 2
- Issued by
- Benzie County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request Form from the Michigan Department of Corrections (MDOC) used to conduct criminal history checks for individuals seeking access to MDOC facilities. The form is associated with the Lakeland Correctional Facility Paving Repair and Replacement project (File #472/23287.JLM). The document serves as a standard background screening tool for employment candidates, human resources personnel, contractors, visitors, volunteers, and other individuals requiring entry into the secure perimeter or property of an MDOC facility to perform work, conduct visits, or interact with offenders.
The form requires applicants to provide personal identification information including name, date of birth, address, sex, race, and a valid driver's license or state identification number to enable MDOC to complete the criminal history check. For MDOC employment and human resources purposes, the Department is additionally authorized to review motor vehicle operator license records to determine eligibility for operating vehicles during Department business. Completed forms are reviewed and cleared by MDOC personnel, with notation of any prior convictions where applicable. The LEIN clearance status is documented as either approved or not approved, with the clearance determination being applicable to all categories except visitors.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1 23287.pdf | ||
| Project Statement 23287.pdf | ||
| SAMPLE Billable Rate Contract (Rev 221207).pdf | ||
| RFP Billable Rate 23287.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 Correctional Facility - Paving Repair - Replacement.
File # 472/23287.JLM
File details come from the government source that posted it. Updated .