LEIN Request 25362.pdf
PDF 165 KB Posted
- Solicitation number
- RFP-171-250000002855-2
- Issued by
- Gogebic County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC) related to the Central Correctional Facility (STF) Various HVAC Improvements project. The form is designed to conduct a criminal history check for individuals seeking to enter a secure MDOC facility, whether for employment, contracting, volunteering, or visitation. The form requires detailed personal identification information, including driver's license or state ID number, date of birth, race, sex, and authorizes the MDOC to perform a comprehensive background check.
The form is specifically associated with the 472.25362.CTS project, which appears to involve HVAC improvements at a central correctional facility. Individuals completing the form must provide consent for a criminal history check and, for employment purposes, authorization to review their motor vehicle operator license record. The form includes sections for MDOC personnel to record LEIN check results, including whether the check is cleared and the number of convictions, if applicable. This document serves as a critical screening tool to ensure the safety and security of MDOC facilities by vetting individuals who may enter the secure perimeter.
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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):
Central Correctional Facility (STF) – Various HVAC Improvements
472.25362.CTS
File details come from the government source that posted it. Updated .