LEIN Request 24263.pdf
PDF 135 KB Posted
- Attached to
- 472/24263. SAA; WHVCF - Roof Replacement Phase 2
- Solicitation number
- RFQ 171 260000000336 2
- Issued by
- Washtenaw County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form issued by the Michigan Department of Corrections (MDOC) for criminal history background checks related to the WHVCF Prisoner Service Building and Fieldhouse Roof Replacement project (File #472/24263.SAA). The form is used to screen individuals—including employment applicants, contractors, visitors, and volunteers—who require access to the secure perimeter or property of MDOC facilities to perform work, conduct visits, or interact with offenders. The form collects personal identifying information including full name, date of birth, sex, race, and either a driver's license number or state identification card number, along with authorization for MDOC to conduct criminal history checks and, for employment purposes, motor vehicle operator license record checks.
The LEIN request form includes certification by MDOC HR/employment personnel and provides spaces to document whether the LEIN clearance was completed and approved. For MDOC employment or human resources purposes, the form allows notation of conviction counts and optional comments. This administrative document serves as a prerequisite screening mechanism to ensure individuals entering MDOC facilities meet security and eligibility requirements for the roof replacement project at the Winn Correctional and Vocational Facility (WHVCF).
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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 - Prisoner Service Building and Fieldhouse Roof Replacement File # 472/24263.SAA
File details come from the government source that posted it. Updated .