LEIN Request 472 20113 TYC.pdf
PDF 160 KB Posted
- Solicitation number
- RFQ - 171 - 220000000456
- Issued by
- Ionia County, Capac Village, Michigan
About this file
This document is a LEIN Request form from the Michigan Department of Corrections. The form is used to request a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for individuals seeking to enter the secure perimeter or property of an MDOC facility, such as for employment, visitation, or contractor work. The form requires the individual to provide personal information including name, address, date of birth, driver's license or state ID number, race, and sex. The individual must authorize the MDOC to conduct the criminal history check and, if for employment purposes, check the individual's motor vehicle operator license record.
The related state and local contract opportunity is for the Carson City Correctional Facility - Paging and Communications Upgrade project, identified as Contract #472/20113.TYC. This project requires bidders to submit questions via email to the designated contact, Bret Emerson, and to upload bid attachments to the SIGMA VSS system. The bid submission deadline is 2:00 PM. COVID-19 precautions may require bidders to wear masks when attending meetings. The project location spans Ionia County and Capac Village.
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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:Carson City, Paging/Comm Upgrades File : 472/20113.TYC
File details come from the government source that posted it. Updated .