LEIN Request 25139.pdf
PDF 160 KB Posted
- Solicitation number
- RFP-171-250000001703-2
- Issued by
- Chippewa 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 conduct criminal history checks for individuals seeking to enter secure MDOC facility perimeters or properties. The form is specifically associated with the KCF - PA Upgrade project (File #472/25139.ABG) and requires detailed personal identification information including driver's license or state ID number, date of birth, race, sex, and contact details. Individuals must authorize MDOC to perform a criminal history check and potentially review their motor vehicle operator license record.
The form serves as an administrative screening tool for contractors, visitors, volunteers, or other personnel who may interact with MDOC offenders, with checkboxes to indicate the individual's status and purpose for facility access. The LEIN request allows MDOC to comprehensively evaluate an individual's background before granting permission to enter correctional facilities, with sections for MDOC personnel to record the results of the criminal history check, including the number of convictions and overall clearance status. The document is part of MDOC's standard security and personnel screening protocol, ensuring safety and compliance when non-MDOC personnel engage with correctional facilities.
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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: KCF - PA Upgrade File # 472/25139.ABG
File details come from the government source that posted it. Updated .