LEIN Request 24059.pdf
PDF 166 KB Posted
- Solicitation number
- RFQ 171 260000000347 4
- Issued by
- Huron County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request Form CAJ-1037 from the Michigan Department of Corrections (MDOC) used to facilitate criminal history checks for individuals requiring access to MDOC facilities. The form is designed to collect personal identification information including driver's license or state identification number, date of birth, race, and sex from employment candidates, contractors, visitors, volunteers, or other individuals who need to enter the secure perimeter or property of an MDOC facility. The specific project referenced is WHVCF - VMS Genetec Ph 2 Cameras (File #472/24059.SAA). Requesters must indicate whether they are MDOC HR personnel, a requesting contractor, visitor, contractor agency representative, volunteer, or other designated category, and must authorize the MDOC to conduct both criminal history checks and, for employment purposes, motor vehicle operator license record checks.
The form serves as a prerequisite clearance document rather than a procurement or contracting instrument. Completion requires the requestor's signature and date, with MDOC personnel subsequently conducting the LEIN check and documenting clearance status. For MDOC employment and human resources purposes, the form includes space to indicate the number of convictions and optional comments. This administrative form is essential for security and safety protocols at MDOC facilities and represents standard background screening procedures applicable to individuals with facility access, regardless of their capacity or role.
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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 .