LEIN Request 26279.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ 171 270000000025 3
- Issued by
- Michigan
About this file
This 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 designed to collect personal information and authorize criminal history background checks for individuals seeking access to secure perimeters or properties at Michigan Department of Corrections facilities. The form requires applicants to provide identification information including driver's license or state ID number, date of birth, race, and sex. Requesters must authorize the MDOC to conduct a criminal history check to determine eligibility to enter secure facility areas for work, visits, meetings, or interactions with MDOC offenders. For MDOC Human Resources and employment purposes, the Department is also authorized to check motor vehicle operator license records to determine eligibility to operate vehicles during Department business.
The form includes fields for signature and date authorization, as well as space for MDOC personnel to document completion of the LEIN check and indicate whether the applicant was cleared for facility access. For HR and employment purposes, the form allows notation of conviction history and optional comments. This LEIN request represents a standard security clearance prerequisite for the referenced water softener and salt storage upgrade project at Lakeland Correctional Facility, ensuring that all personnel with facility access undergo appropriate criminal background screening.
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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 .