LEIN Request 26360.pdf
PDF 160 KB Posted
- Solicitation number
- RFP 171 260000002449 1
- Issued by
- Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history background checks related to facility access. The form is used to screen individuals—including employees, contractors, visitors, and volunteers—who require authorization to enter the secure perimeter or property of MDOC facilities. The request form CAJ-1037 (Rev. 09/19) requires applicants to provide personal identification information including driver's license or state identification number, date of birth, race, and sex. The form specifies that authorization is needed to perform work, conduct visits, meet with, or work with MDOC offenders. For this particular request, the facility involved is the Green Oaks Training Center - Facility Equipment Storage Building (File # 472/26360.KMM).
The form functions as a preliminary screening document that allows MDOC to conduct background checks through the Michigan Law Enforcement Information Network prior to granting facility access. For MDOC Human Resources and Employment purposes, the Department is also authorized to review motor vehicle operator license records to determine eligibility for operating vehicles during Department business. The form requires applicant signature and authorization, with completion and clearance documented by MDOC personnel. The LEIN clearance status is marked as either cleared or not cleared, with notation of any conviction history and optional comments maintained in the personnel file.
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Other files
| File | Type | Posted |
|---|---|---|
| SAMPLE Billable Rate Contract (Rev 04-25).pdf | ||
| Project Statement 26360.pdf | ||
| RFP Billable Rate 26360.pdf |
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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: Green Oaks Training Center - Facility Equipment Storage Building File # 472/26360.KMM
File details come from the government source that posted it. Updated .