LEIN Request 25266.pdf
PDF 174 KB Posted
- Attached to
- 472/25266. JBB; Alger CF - Roof Replacement
- Solicitation number
- RFQ 171 260000000223 2
- Issued by
- Alger County, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Law Enforcement Information Network (LEIN) Request Form used to conduct criminal history checks for individuals seeking access to MDOC facilities. The form is associated with the Alger Correctional Facility Roof Replacement project (File #472/25266.JBB). The document serves as a pre-screening tool for employment, contractor, visitor, and volunteer personnel who require entry into the secure perimeter or property of an MDOC facility to perform work, conduct visits, or interact with offenders. The form collects personal identification information including driver's license or state identification number, date of birth, race, and sex to facilitate the criminal history background check through Michigan's law enforcement database.
The LEIN request form requires the applicant's authorization for the MDOC to conduct both criminal history checks and, for employment purposes, motor vehicle operator license record checks. Completion of the form is documented by MDOC personnel, who note whether the individual has been cleared for facility access. The form includes optional fields for recording conviction information and comments related to the background check results. This administrative document is a mandatory prerequisite for any individual requiring access to MDOC secure facilities in connection with contractor work or other authorized activities.
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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: Alger C.F. - Roof Replacement
File # 472/25266.JBB
File details come from the government source that posted it. Updated .