LEIN Request 25257.pdf
PDF 123 KB Posted
- Solicitation number
- RFP-171-250000002555-3
- Issued by
- Chippewa County, Michigan
About this file
The document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC), specifically associated with the Kinross CF - Fire Alarm System Upgrades project (File # 472/25257.ABG). The form is designed to conduct a criminal history check for individuals seeking to enter a secure MDOC facility, whether for employment, contractor work, volunteering, or visitation. The form requires detailed personal identification information, including driver's license or state ID number, date of birth, race, sex, and authorization for a comprehensive background check.
The LEIN Request serves as a standard screening mechanism for the MDOC to verify an individual's eligibility to access correctional facilities, with specific provisions for both facility entry and potential employment purposes. The form allows the department to check criminal history and, for employment-related requests, review motor vehicle operator license records to determine an individual's suitability for conducting department business. The form is part of a standardized process to ensure security and compliance within the Michigan Department of Corrections system, with options for HR personnel, contractors, volunteers, and other potential facility visitors to undergo necessary background screenings.
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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: Kinross CF - Fire Alarm System Upgrades File # 472/25257.ABG
File details come from the government source that posted it. Updated .