LEIN Request 26279.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ 171 270000000025 2
- Issued by
- Bay County, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request Form CAJ-1037 issued by the Michigan Department of Corrections for the Lakeland Correctional Facility Water Softener & Salt Storage Upgrades project (File #472/26279.JLM). The form is used to conduct criminal history checks for individuals seeking access to the secure perimeter or property of an MDOC facility. The form requires completion by employment/human resources personnel, requesting contractors, visitors, contractors, volunteers, or other representatives to provide personal identification information including driver's license or state identification number, date of birth, race, and sex. The document indicates that authorization is being sought for individuals to enter secure facility areas to perform work, conduct visits, meet with staff, or work with offenders in connection with this water softener and salt storage upgrade project at Lakeland Correctional Facility.
The form includes optional sections for MDOC HR/Employment purposes to document motor vehicle operator license checks and the number of convictions, with space for comments. The LEIN clearance section indicates whether the background check has been completed and cleared, though this particular form appears to be a blank or template version. No specific pricing terms, contract amounts, set-asides, or other financial details are contained within this background check authorization document.
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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: Lakeland Correctional Facility - Water Softener & Salt Storage Upgrades
File # 472/ 26279.JLM
File details come from the government source that posted it. Updated .