LEIN Request 25140.pdf
PDF 160 KB Posted
- Attached to
- 472/25140. ABG; Kinross CF - PPD System Upgrade
- Solicitation number
- RFP-171-250000001702-5
- Issued by
- Chippewa County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC) for the KCF - PPD System Upgrade project, with a file number of 472/25140.ABG. The form is designed to conduct a criminal history check for individuals seeking to enter a secure MDOC facility, whether for employment, contracting, volunteering, or visiting. It requires detailed personal information including identification numbers, date of birth, race, sex, and requires authorization for a comprehensive background check.
The form serves as a standard procedure for vetting individuals who will have access to MDOC facilities, with specific provisions for both facility entry and potential employment purposes. The document allows MDOC to not only check criminal history through the LEIN system but also to review motor vehicle operator license records if the individual may operate a vehicle while conducting department business. The form is marked as revision 09/19 and includes sections for official MDOC personnel to complete the LEIN check and record the results, including noting the number of convictions if applicable.
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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 - PPD System Upgrade File # 472/25140.ABG
File details come from the government source that posted it. Updated .