LEIN Request 23353.pdf
PDF 24 KB Posted
- Solicitation number
- RFQ - 171 - 240000000282
- Issued by
- Jackson County, Michigan
About this file
The document is a LEIN Request form from the Michigan Department of Corrections, which is required for vendors or contractors to be approved for entry into a Michigan Department of Corrections facility. The form requests personal information such as name, address, date of birth, sex, race, and identification numbers to conduct a criminal history check through the Michigan Law Enforcement Information Network (LEIN). Completion and clearance of this LEIN check is required for potential entry into MDOC facilities.
The related state and local contract opportunity is for asphalt repairs at the Cooper Street Correctional Facility, identified as File #472/23353.DPL. The project is located in Jackson County, Michigan. No further details about the contract opportunity are provided in the document.
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 03/15
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 and your Social Security Number is needed to complete this LEIN. Also needed are your date-of-birth, race and sex. Potential entry into MDOC facilities require that this LEIN check be completed and cleared.
Profession Vendor Contractor
Last Name (Please Print)
First Name Middle Name
Address
City State Zip Code
Date of Birth Sex Race
Please provide the number of at least two of the following three types of identification:
Driver’s License # State issued by
State ID # State issued by
Social Security #
I authorize the Michigan Department of Corrections to conduct a criminal history check, so that I may be approved to visit/meet with persons confined in a Michigan Department of Corrections facility.
Signature Date
Staff Use Only
Reason for LEIN Check
Staff requesting LEIN Check
LEIN Checked by
LEIN Clear Yes No, You may obtain a copy of your Michigan criminal history at www.michigan.gov/ichat. There is a fee for this service.
LEIN Check completed by Initials Date http://www.michigan.gov/ichat hallt2 Text Box Facility/Project Name: Cooper Street CF - Asphalt Repairs File # 472/23353.DPL
File details come from the government source that posted it. Updated .