LEIN Request 25278.pdf
PDF 174 KB Posted
- Attached to
- 472/25278. RWG; Ionia C.F. - IT Room Expansion
- Solicitation number
- RFQ 171 270000000032 2
- Issued by
- Michigan
About this file
This document is a LEIN (Michigan Law Enforcement Information Network) Request Form CAJ-1037, revision 09/19, issued by the Michigan Department of Corrections in connection with the Ionia Correctional Facility IT Room Expansion project (File #472/25278.RWG). The form is used to initiate criminal history checks for individuals requiring access to the secure perimeter or property of MDOC facilities. The form collects personal identifying information including the applicant's name, date of birth, sex, race, address, and driver's license or state identification card number. Applicants must authorize the MDOC to conduct a criminal history check as a condition of approval to enter secure areas of MDOC facilities for work, visitation, or interaction with offenders.
For MDOC Human Resources and employment purposes, the form includes additional authorization for motor vehicle operator license record checks to determine eligibility to operate vehicles during Department business. The form designates space for LEIN completion and clearance documentation, including fields for recording the number of convictions and optional comments. This form represents a standard security and background verification requirement for contractors and personnel working on projects within MDOC facilities, ensuring compliance with facility access protocols and institutional safety procedures.
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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: Ionia C.F. - IT Room Expansion
File # 472/25278.RWG
File details come from the government source that posted it. Updated .