LEIN Request 25139.pdf
PDF 160 KB Posted
- Solicitation number
- RFP 171 250000001703 4
- Issued by
- Cass County, Michigan
About this file
This is a Criminal History Check Request Form (LEIN Request CAJ-1037) issued by the Michigan Department of Corrections (MDOC) for individuals requiring access to secure facilities. The form is used to conduct background checks through the Michigan Law Enforcement Information Network (LEIN) for employment candidates, contractors, visitors, and volunteers seeking entry to MDOC facilities or interaction with offenders. The specific project referenced is the KCF - PA Upgrade (File #472/25139.ABG). The form requires submission of personal identification information including driver's license or state ID number, date of birth, race, and sex to complete the criminal history verification process. Authorization for the background check must be provided by signature and date, with MDOC personnel responsible for completing and clearing the LEIN check.
The form serves as a prerequisite clearance document with no pricing terms, set-asides, or funding information applicable, as it functions solely as a security and eligibility screening tool. Completion and clearance of the LEIN check is mandatory for all personnel entering the secure perimeter of MDOC facilities, regardless of employment status or contractor classification. The form includes optional sections for documenting conviction counts and additional comments for MDOC HR and employment purposes. No contract term, renewal options, or performance metrics are specified within this clearance request document.
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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 .