LEIN Request 25256.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ 171 260000000218 4
- Issued by
- Alger County, Westland City, Michigan
About this file
This is a LEIN Request Form (CAJ-1037, Revised 09/19) issued by the Michigan Department of Corrections (MDOC) for criminal history background check purposes. The form is associated with a facility/project identified as MDOC/Alger Correctional Facility - Cooler/Freezer Replacement (File #472/25256.JBB). The document is a standardized template designed to collect personal information and identification details from individuals requiring access to secure perimeters or properties at MDOC facilities. Information gathered includes the applicant's full name, date of birth, address, sex, race, and driver's license or state identification card number. The form authorizes MDOC to conduct a criminal history check through the Michigan Law Enforcement Information Network (LEIN) to determine eligibility for entry into secure facility areas for work, visits, or offender-related activities.
The form is applicable to MDOC employees, human resources personnel, contractors, visitors, volunteers, and other individuals requiring facility access. For employment and human resources purposes, the form includes provisions for motor vehicle operator license record checks to assess eligibility for operating vehicles during department business. The requesting form must be completed by authorized LEIN personnel and cleared accordingly, with notation of conviction counts and optional comments. This document serves as a prerequisite administrative requirement for the cooler/freezer replacement project at Alger Correctional Facility and does not contain pricing, contract terms, or procurement specifications.
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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 .