LEIN Request 25256.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ 171 260000000218 3
- Issued by
- Alger County, Michigan
About this file
This file is a LEIN (Michigan Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections for the Alger Correctional Facility Cooler/Freezer Replacement project (File #472/25256.JBB). The form is used to conduct criminal history checks for individuals requiring access to the secure perimeter or property of MDOC facilities. The document applies to employment candidates, human resources personnel, requesting contractors, visitors, volunteers, and other representatives needing approval to enter secure areas to perform work, conduct visits, meet with, or work with MDOC offenders.
The LEIN Request form requires submission of personal identification information including driver's license or state identification number, date of birth, race, and sex to complete the criminal history check process. The form includes authorization for the MDOC to conduct criminal history checks and, for HR/employment purposes, to review motor vehicle operator license records to determine eligibility to operate vehicles while conducting Department business. The requesting party must sign and date the form, which is then completed and cleared by MDOC personnel. The form includes a section for MDOC HR/employment purposes to document the number of convictions and optional comments regarding the applicant's clearance status.
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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: MDOC / Alger Correctional Facility - Cooler/Freezer Replacement
File # 472/25256.JBB
File details come from the government source that posted it. Updated .