LEIN Request 23439.pdf
PDF 174 KB Posted
- Solicitation number
- RFQ 171 250000000120 2
- Issued by
- Arenac County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history background checks. The form is utilized to screen personnel requiring access to MDOC secure facilities, including employees, contractors, visitors, and volunteers. The specific project referenced is the Baraga Correctional Facility UST (Underground Storage Tank) Removal and Replacement project, identified as File #472/23439.IND. The form collects personal identification information including driver's license or state identification number, date of birth, race, and sex to complete the criminal history check necessary for facility access approval.
The LEIN request process requires authorized individuals to provide comprehensive personal information and authorize the MDOC to conduct criminal background checks and, for employment purposes, motor vehicle operator license record reviews. The form includes fields for recording conviction history and optional comments for MDOC Human Resources purposes. Completion and clearance of the LEIN request is a prerequisite for any individual seeking to enter the secure perimeter of an MDOC facility to perform work or conduct business related to the Baraga CF UST removal and replacement project.
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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: Baraga CF UST Removal & Replacement File # 472/23439.IND
File details come from the government source that posted it. Updated .