LEIN Request 24459.pdf
PDF 123 KB Posted
- Attached to
- 472/24459. TAP; Baraga CF - Exhaust Fan Upgrades
- Solicitation number
- RFP-171-250000001970-2
- Issued by
- Arenac County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections (MDOC), designed to facilitate a criminal history check for individuals seeking to enter a secure MDOC facility. The form is specifically associated with the Baraga CF - Exhaust Fan & Smoke Purge System Upgrade project (File #472/24459.TAP), and is intended for contractors, visitors, volunteers, or other personnel who may need access to a corrections facility.
The form requires detailed personal information including name, address, date of birth, sex, race, and identification number (driver's license or state ID). By signing the document, the individual authorizes MDOC to conduct a comprehensive criminal history check and, for employment purposes, to review their motor vehicle operator license record. The form allows MDOC personnel to verify an individual's eligibility to enter facility premises or perform work involving interaction with offenders, with sections for MDOC staff to complete the LEIN check and record the results.
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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: Baraga CF - Exhaust Fan & Smoke Purge System Upgrade File # 472/24459.TAP
File details come from the government source that posted it. Updated .