LEIN Request 24055.pdf
PDF 174 KB Posted
- Solicitation number
- RFQ 171 260000000384 2
- Issued by
- Michigan
About this file
This file is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC) related to contract opportunity 472/24055.DPL for Smoke Purge System Repair/Replace work at the Gus Harrison Correctional Facility. The form is used to conduct criminal history checks for individuals requiring access to the secure perimeter or property of MDOC facilities to perform work, conduct visits, or interact with MDOC offenders. The form collects personal identification information including driver's license or state identification card number, date of birth, race, and sex, along with the requestor's full name and address. Requestors must indicate their affiliation category, such as employment/HR personnel, contractor, visitor, volunteer, or other agency representative.
The LEIN clearance process is completed by MDOC personnel who verify whether the criminal history check has been cleared for facility access. The form includes authorization for MDOC to conduct the criminal history check and, for HR/employment purposes, authorization to check motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The specific project associated with this request is the Smoke Purge System Repair/Replace project at Gus Harrison Correctional Facility, filed under number 472/24055.DPL. This document serves as a security screening tool rather than a procurement or contracting 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: Gus Harrison C.F. - Smoke Purge System Repair/ Replace
File # 472/24055.DPL
File details come from the government source that posted it. Updated .