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
- Baraga County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request Form (CAJ-1037, Revised 09/19) issued by the Michigan Department of Corrections for criminal history background check purposes. The form is associated with a facility upgrade project at Baraga Correctional Facility (File #472/24459.TAP) involving an Exhaust Fan & Smoke Purge System Upgrade. The document requests personal identification information from individuals seeking access to the secure perimeter or property of MDOC facilities, including name, date of birth, address, sex, race, and driver's license or state identification card number. Individuals completing this form authorize MDOC to conduct a criminal history check through the Michigan Law Enforcement Information Network to determine eligibility for entry into secure facility areas for work, visitation, or offender contact purposes.
The form includes a section for MDOC HR/Employment personnel to document completion of the LEIN check, clearance status, and any relevant conviction history information. For employment-related purposes, the form also authorizes MDOC to review the applicant's motor vehicle operator license record to determine eligibility for operating vehicles during Department business. This form serves as a prerequisite screening document rather than a bid document and does not contain pricing, contract terms, funding information, or procurement specifications related to the Baraga Correctional Facility exhaust fan and smoke purge system upgrade 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: Baraga CF - Exhaust Fan & Smoke Purge System Upgrade File # 472/24459.TAP
File details come from the government source that posted it. Updated .