LEIN Request 24056.pdf
PDF 123 KB Posted
- Solicitation number
- RFP - 171 - 240000001521
- Issued by
- Lenawee County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request Form from the Michigan Department of Corrections (MDOC). The purpose of this form is to conduct a criminal history check for an individual who is requesting to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with, or work with MDOC offenders. The form requires the individual to provide their 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, check their motor vehicle operator license record.
The related state and local contract opportunity is for the Gus Harrison Correctional Facility - Cell Door Controls - Locks project, located in Lenawee County, Michigan. The project's file number is 472/24056.DPL, and it appears to be a facility upgrade or maintenance project, though the specific scope of work is not provided in this document.
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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 CF - Cell Door Controls - Locks File # 472/24056.DPL
File details come from the government source that posted it. Updated .