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
- Cass County, Kincheloe CDP, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request Form used by the Michigan Department of Corrections (MDOC) to conduct criminal history checks for individuals seeking access to MDOC facilities. The form, designated CAJ-1037 (Rev. 09/19), is associated with File #472/25140.ABG and the KCF - PPD System Upgrade project. The document functions as a background clearance tool rather than a traditional procurement document, requiring applicants to provide personal identifying information including driver's license or state identification number, date of birth, race, and sex. The form determines eligibility for individuals entering the secure perimeter of MDOC facilities in various capacities, including employment, human resources, contracting, visiting, volunteer work, or offender-related activities.
The LEIN Request Form requires applicant signatures authorizing MDOC to conduct criminal history checks and, for HR/employment purposes, to review motor vehicle operator license records. The form includes fields for facility/project identification and optional comments regarding conviction history. MDOC personnel complete the LEIN check and indicate clearance status as either approved or denied. This background screening mechanism serves as a prerequisite for contract performance and facility access rather than establishing pricing terms, funding sources, or renewal options typical of procurement solicitations.
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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 .