LEIN Request 25324.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ-171-250000000561-2
- Issued by
- Clare County, Michigan
About this file
The document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC), specifically related to the Chippewa - Powerplant Steam Surge Tank Replacement project (File # 472/25324.ABG). This 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, contractor work, visitation, volunteering, 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 the MDOC to perform a comprehensive criminal history check and, for employment purposes, to review the individual's motor vehicle operator license record. The form includes sections for various categories of entry (such as contractor, volunteer, or visitor) and requires the individual to indicate whether they will be entering a secure MDOC facility. The document is part of the standard security protocol for the Chippewa facility project, ensuring that all personnel accessing the site have undergone appropriate background screening. The form is dated September 2019 (REV. 09/19) and uses the standard MDOC form CAJ-1037 for LEIN requests.
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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: Chippewa - Powerplant Steam Surge Tank Replacement File # 472/25324.ABG
File details come from the government source that posted it. Updated .