LEIN Request 25271.pdf
PDF 260 KB Posted
- Solicitation number
- RFQ-171-250000000570-3
- Issued by
- Wayne County, Flint City, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) for the Saginaw Correctional Facility's Warehouse Concrete Repair project, with the project number 472/25271.CTS. The form is designed to conduct a criminal history check for individuals seeking to enter the secure perimeter or property of an MDOC facility, whether for employment, contractual work, visiting, or other purposes. The form requires detailed personal identification information, including driver's license or state ID number, date of birth, race, and sex, to complete the background check.
The form authorizes MDOC to perform a comprehensive background investigation, including a criminal history check and, for employment purposes, a review of the individual's motor vehicle operator license record. The individual must provide consent by signing the form, acknowledging the background check's purpose of determining suitability to enter an MDOC facility or work with offenders. The form includes checkboxes for various categories such as employment, contractor, volunteer, or visitor, and requires specification of whether the individual will be entering the secure perimeter of an MDOC facility. The final section of the form is reserved for MDOC personnel to record the LEIN check results and any additional comments or conviction details.
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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):
Facility/Project Name: Saginaw Correctional Facility – Warehouse Concrete Repair Project Number: 472/25271.CTS
File details come from the government source that posted it. Updated .