LEIN Request 26319.pdf
PDF 173 KB Posted
- Attached to
- 472/26319. SMD; Handlon C. F. Unit B Conversion
- Solicitation number
- RFQ 171 260000000443 1
- Issued by
- Michigan
About this file
This is a criminal history check request form (CAJ-1037, Revision 09/19) issued by the Michigan Department of Corrections (MDOC) for the Handlon Correctional Facility Unit B Conversion project (File #472/26319.SMD). The form is used to authorize Law Enforcement Information Network (LEIN) criminal history checks for individuals requiring access to the secure perimeter or property of MDOC facilities. The form collects personal identification information including name, date of birth, sex, race, address, and driver's license or state identification card number from employment and human resources personnel, contractors, visitors, volunteers, or other agency representatives. Requestors must authorize the MDOC to conduct criminal history checks and motor vehicle operator license record checks for those operating vehicles during Department business. The form includes fields for documenting the number of convictions and optional comments, along with signature blocks for the requestor and MDOC personnel completing and clearing the LEIN request.
This form serves as a screening and compliance document rather than a procurement or contracting instrument. It establishes the security clearance and background verification requirements necessary for personnel access to MDOC facilities during the Unit B Conversion project. The form does not contain pricing, contract terms, funding information, or other procurement specifications, as it functions solely as an administrative tool for vetting individuals before allowing them entry to secure correctional facilities.
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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: Handlon C.F. - Unit B Conversion File # 472/26319.SMD
File details come from the government source that posted it. Updated .