LEIN Request 24059.pdf
PDF 166 KB Posted
- Solicitation number
- RFQ 171 260000000347 3
- Issued by
- Washtenaw County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) related to contract opportunity 472/24059.SAA for WHVCF - VMS Genetec Phase 2 Cameras. The form is used to conduct criminal history checks for individuals requiring access to the secure perimeter or property of an MDOC facility. The document requires submission of personal information including driver's license or state identification number, date of birth, race, and sex. The request form designates the individual's role as employment/human resources personnel, requesting contractor, visitor, contractor agency representative, volunteer, or other agency representative. Completion of the LEIN check is mandatory for approval to enter secure MDOC facility areas to perform work, conduct visits, meet with staff, or work with MDOC offenders.
The form includes authorization for the MDOC to conduct both criminal history checks and, for employment purposes, motor vehicle operator license record checks to determine eligibility to operate vehicles during department business. The requesting party must sign and date the authorization, and the form must be completed and cleared by MDOC LEIN personnel. For MDOC employment or HR purposes, the form includes a field to record the number of convictions and optional comments. This administrative requirement applies to all contract personnel and visitors seeking access to the facility in connection with the Genetec Phase 2 camera 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: WHVCF - VMS Genetec Ph 2 Cameras File # 472/24059.SAA
File details come from the government source that posted it. Updated .