LEIN Request 25140.pdf
PDF 160 KB Posted
- Attached to
- 472/25140. ABG; Kinross CF - PPD System Upgrade State and local contract opportunity
- Solicitation number
- RFP-171-250000001702-2
- Issued by
- Chippewa County, Kincheloe CDP, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Law Enforcement Information Network (LEIN) Request form for a specific project at the Kinross Correctional Facility (KCF) involving a PPD System Upgrade, with the file number 472/25140.ABG. The document is a standard criminal history check authorization form that allows individuals to be approved for entry into secure MDOC facility perimeters, with the specific purpose of performing work, visiting, meeting with, or working with MDOC offenders.
The form requires detailed personal identification information, including driver's license or state ID number, date of birth, race, and sex, to conduct a comprehensive background check. The individual completing the form must authorize the MDOC to perform a criminal history check and, for employment purposes, allow the department to review their motor vehicle operator license record. The form is part of the standard security protocol for contractors, visitors, volunteers, or other personnel seeking access to MDOC facilities, with a checkbox to indicate whether the individual will be entering the secure perimeter/property of an MDOC facility.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 472-25140-ABG Kinross PPD System - Addendum 1.pdf | ||
| SAMPLE Billable Rate Contract (Rev 221207).pdf | ||
| 25140 Kinross PPD System - Project Statement.pdf | ||
| 25140 Kinross PPD System - RFP Billable Rate.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 - PPD System Upgrade File # 472/25140.ABG
File details come from the government source that posted it. Updated .