LEIN Request 25257.pdf
PDF 123 KB Posted
- Solicitation number
- RFP 171 250000002555 3
- Issued by
- Chippewa County, Kincheloe CDP, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history background check authorization. The form is associated with the Kinross Correctional Facility Fire Alarm System Upgrades project (File #472/25257.ABG). The document serves as the official request mechanism for conducting criminal history checks on individuals requiring access to the secure perimeter or property of MDOC facilities. Individuals subject to this requirement include employees, contractors, visitors, volunteers, and other personnel who need to enter MDOC facilities to perform work, conduct visits, meet with staff, or work with offenders. The form collects personal identification information including driver's license or state identification number, date of birth, race, and sex necessary to complete the background check through the LEIN database.
The form authorizes MDOC to conduct comprehensive criminal history checks and, for HR and employment purposes, to review motor vehicle operator license records to determine eligibility for operating vehicles during Department business. The form requires signature and date authentication from the subject individual and includes completion and clearance sections for MDOC personnel, with notation fields for conviction records and optional comments. This background check process is a mandatory security requirement for facility access and must be cleared before personnel are permitted to enter secure areas of MDOC facilities.
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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 .