LEIN Request 26288.pdf
PDF 166 KB Posted
- Solicitation number
- RFP 171 260000002155 1
- Issued by
- Michigan
About this file
This is a LEIN Request form (CAJ-1037, Revised 09/19) issued by the Michigan Department of Corrections (MDOC) related to the Egeler RGC Dining Hall Improvements project (File #472/226288.GSA). The form is used to conduct criminal history checks through the Michigan Law Enforcement Information Network (LEIN) for individuals requiring access to the secure perimeter or property of MDOC facilities. The form collects personal identification information including driver's license or state identification card number, date of birth, race, and sex to complete the criminal history background check. Requesters must indicate their affiliation with MDOC, whether as HR personnel, contractors, visitors, volunteers, or other representatives, and confirm whether they will be entering a secure perimeter or facility property. The form requires authorization from the individual for the criminal history check and, for MDOC HR/Employment purposes, allows the Department to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business.
The form includes fields for documenting the completion and clearance status of the LEIN check, with space for indicating the number of convictions and optional comments. This background check requirement applies to all personnel and contractors working on the Egeler RGC Dining Hall Improvements project and represents a standard security protocol for MDOC facility access. No specific pricing, contract terms, renewal options, or funding information is contained in this form, as it serves solely as a background clearance document in the contracting process rather than a procurement document itself.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Project Statement.pdf | ||
| floor plan.jpg | JPG image | |
| RFP Billable Rate 26288.pdf | ||
| SAMPLE Billable Rate Contract (Rev 04-25).pdf | ||
| floor plan.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: Egeler RGC - Dining Hall Improvements File # 472/226288.GSA
File details come from the government source that posted it. Updated .