LEIN Request 24055.pdf

123 KB Posted

Attached to
472/24055. DPL; Gus Harrison CF - Smoke Purge System
Solicitation number
RFP - 171 - 240000001338
Issued by
Lenawee County, Michigan

About this file

Written by GovTribe AI ·

The document provided is a LEIN (Michigan Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC). This form is used to request a criminal history check for individuals who need to enter the secure perimeter or property of an MDOC facility to perform work, visit, or meet with offenders. The form requires the individual's personal information, such as name, address, date of birth, sex, race, and driver's license or state ID number. The individual must sign the form to authorize the MDOC to conduct the criminal history check and, if applicable, a motor vehicle operator license record check.

The state and local contract opportunity referenced in the document is for the Gus Harrison Correctional Facility in Lenawee County, Michigan, to repair or replace the smoke purge system. The project file number is 472/24055.DPL.

View the file

Other files

File Type Posted
Project Statement 24055.pdf PDF
MDOC Physical Plant Design Standardizations Manual.pdf PDF
472-24055 RFP Addendum 1.pdf PDF
20088.00 Smoke Purge Guidelines Standards.pdf PDF
MDOC Appendix II Special Working Conditions as of March 2023.pdf PDF
DTMB-0427 Project Statement - Gus Harrison Smoke Purge (REVISED).pdf PDF
SAMPLE Billable Rate Contract (Rev 221207).pdf PDF
RFP Billable Rate 24055.pdf PDF
MDOC and DTMB-DCD Project Roles and Duties (rev 01-31-17) EV-1.pdf PDF

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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: Gus Harrison CF - Smoke Purge System Repair / Replacement File # 472/24055.DPL

File details come from the government source that posted it. Updated .