LEIN Request 25256.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ 171 260000000218 5
- Issued by
- Alger County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request Form CAJ-1037 issued by the Michigan Department of Corrections (MDOC) for criminal history clearance purposes. The form is associated with a facility project at MDOC's Alger Correctional Facility for cooler and freezer replacement (File #472/25256.JBB). The document serves as a standardized background check request required for individuals entering the secure perimeter or property of MDOC facilities to perform work, conduct visits, meet with staff, or work with MDOC offenders. The form collects personal identification information including driver's license or state identification card number, date of birth, race, and sex to facilitate the criminal history check through the LEIN system.
The form authorizes MDOC to conduct a comprehensive criminal history check and includes an optional authorization for checking motor vehicle operator license records for employees and HR purposes to determine eligibility to operate vehicles while conducting Department business. The form includes fields for documenting the number of convictions and optional comments for MDOC HR employment purposes. Completion and clearance of the LEIN request are documented by MDOC personnel through signature and date fields, with a yes/no indication of whether the applicant has been cleared. This background clearance process is a prerequisite requirement for anyone seeking access to MDOC secure facilities in connection with contract work, including the ongoing cooler and freezer replacement project at Alger Correctional Facility.
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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 .