LEIN Request 24262.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ 171 260000000358 2
- Issued by
- Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form CAJ-1037 issued by the Michigan Department of Corrections (MDOC) for File Number 472/24262.JBB, related to the Alger Correctional Facility Paging System Replacement project. The form is used to conduct criminal history checks for individuals requiring access to the secure perimeter or property of an MDOC facility to perform work, visit, or meet with MDOC offenders. The document requests personal identification information including the applicant's driver's license or state identification number, date of birth, race, and sex. Applicants must authorize MDOC to conduct a criminal history check and, for HR/employment purposes, authorize verification of motor vehicle operator license records to determine eligibility to operate vehicles while conducting Department business. The form includes sections for the requesting contractor or HR personnel to document whether the individual is cleared to enter secure facility areas.
The LEIN Request form serves as a prerequisite security clearance mechanism rather than a procurement document with pricing, set-asides, or funding information. It functions as a mandatory screening tool for all personnel seeking access to MDOC facilities and is completed by MDOC HR/Employment personnel or authorized representatives. The form references the Alger Correctional Facility Paging System Replacement project but does not contain contract-specific terms, award information, or project timelines. This document represents the administrative compliance requirement that contractors and their personnel must satisfy before commencing work on the identified MDOC facility 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):
File Number: 472/24059.SAA
Facility/Project Name: Alger CF - Paging System Replacement
File Number: 472/24262.JBB
File details come from the government source that posted it. Updated .