LEIN Request 25355.pdf
PDF 203 KB Posted
- Solicitation number
- RFP 171 250000002848 2
- Issued by
- Saginaw County, Flint City, Michigan
About this file
This is a criminal history check request form issued by the Michigan Department of Corrections (MDOC) for access to secure facilities. The form is used to process Law Enforcement Information Network (LEIN) background checks for individuals seeking entry to MDOC facilities, including employees, contractors, visitors, and volunteers. The specific project referenced is the Saginaw Correctional Facility (SRF) Bar Screen Improvements Project (Project Number 472.25335.CTS). Requestors must provide personal identification information including driver's license or state identification number, date of birth, race, and sex to complete the background screening process. The form indicates whether the individual will be entering the secure perimeter or property of an MDOC facility and requires authorization for the Department to conduct criminal history checks and, for employment purposes, motor vehicle operator license record reviews.
The LEIN request form serves as a gatekeeping mechanism for facility access and includes fields for HR personnel to document the number of convictions and any relevant comments following clearance determination. Completion and clearance of the LEIN check are indicated by signature and date entries from both the requesting party and the MDOC personnel conducting the check. This form is required for all individuals, whether employees or external contractors, who will have contact with MDOC offenders or access to secure correctional facility areas as part of project work or business operations.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP 25355.pdf | ||
| DWG Existing 25355.pdf | ||
| Proj State 25355.pdf | ||
| ADD1 25355.pdf | ||
| SAMPLE Billable Rate Contract (Rev 04-25).pdf |
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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 (SRF) – Bar Screen Improvements Project Number: 472.25335.CTS
File details come from the government source that posted it. Updated .