LEIN Request 26379.pdf
PDF 124 KB Posted
- Solicitation number
- RFP 171 260000002510 2
- Issued by
- Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form CAJ-1037 from the Michigan Department of Corrections used to conduct criminal history checks for individuals seeking access to secure perimeters and facilities. The form is associated with the Handlon Correctional Facility Equipment Operator Vocational Program (File #472/26379.SMD) and applies to employment candidates, contractors, visitors, and volunteers requiring clearance to enter MDOC secure properties or work with offenders.
The form collects personal identification information including driver's license or state identification number, date of birth, race, and sex to facilitate the criminal background check through the LEIN system. Requesters must authorize the MDOC to conduct criminal history checks and, for employment purposes, motor vehicle operator license record checks to determine eligibility for operating vehicles during Department business. The form includes sections for MDOC HR personnel to document the number of convictions and provide optional comments, with designated fields for completion date and clearance approval status.
View the file
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| 26379_RFP_Billable Rate.pdf | ||
| SAMPLE Billable Rate Contract (Rev 04-25).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: Handlon CF - Equipment Operator Vocational Program.
File # 472/26379.SMD
File details come from the government source that posted it. Updated .