LEIN Request 26230.pdf
PDF 159 KB Posted
- Solicitation number
- RFQ 171 260000000378 1
- Issued by
- Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request Form CAJ-1037 issued by the Michigan Department of Corrections in relation to the Macomb Correctional Facility Housing Units 4 & 5 Level IV Conversion project (File #472/26230.MNB). The form is used to initiate criminal history background checks for individuals seeking access to secure perimeters or properties at MDOC facilities. The form requires collection of personal information including driver's license or state identification number, date of birth, race, and sex to complete the criminal history verification process. Requesters must identify their role in relation to the facility, selecting from categories such as HR personnel, contractor, visitor, volunteer, or other agency representative, and must confirm whether they will be entering the secure perimeter or property of an MDOC facility.
The LEIN request form authorizes the MDOC to conduct criminal history checks and, for MDOC HR and employment purposes, to check motor vehicle operator license records to determine eligibility for operating vehicles during Department business. The form includes signature and date fields for the requestor and completion and clearance fields for MDOC LEIN personnel, with space for indicating the number of convictions and optional comments. This administrative form is a prerequisite requirement for access approval to the Macomb Correctional Facility project and represents standard security and background verification procedures for individuals engaged with the Department of Corrections.
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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: Macomb Correctional Facility - Housing Units 4 & 5 Level IV Conversion
File # 472/26230.MNB
File details come from the government source that posted it. Updated .