LEIN Request 26345.pdf
PDF 123 KB Posted
- Solicitation number
- RFP 171 260000002215 1
- Issued by
- Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for use in conjunction with the Baraga Correctional Facility Control Center and EM Room Upgrade project (File #472/26345.TAP). The form is used to initiate criminal history checks for individuals requiring access to the secure perimeter or property of MDOC facilities. The form collects personal identification information including the applicant's name, date of birth, sex, race, address, and driver's license or state identification number. The form indicates whether the individual is entering the facility in one of several capacities: as HR personnel, requesting contractor, visitor, contractor, volunteer, or representing an outside agency. Applicants must authorize the MDOC to conduct a criminal history check through LEIN to gain approval for facility access to perform work, visit, meet with, or work with MDOC offenders.
The form includes additional authorization for motor vehicle operator license record checks for MDOC employment and human resources purposes only. The requesting party or HR personnel must complete the form and obtain signature and date from the applicant. MDOC LEIN personnel then complete the background check and indicate clearance status (yes or no). For MDOC employment purposes, the form includes a field to document the number of convictions and optional comments. This form represents a standard security and background verification requirement for the Baraga Correctional Facility Control Center and EM Room Upgrade project.
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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: Baraga CF - Control Center and EM Room Upgrade File # 472/26345.TAP
File details come from the government source that posted it. Updated .