LEIN Request 472-23129.KMM.pdf
PDF 174 KB Posted
- Solicitation number
- RFQ 171 270000000015 1
- Issued by
- Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form CAJ-1037 from the Michigan Department of Corrections (MDOC) related to the Woodland Correctional Facility Site Mechanical Underground contract opportunity (File #472/23129.KMM). The form is used to conduct criminal history checks for individuals requiring access to secure perimeters or properties at MDOC facilities. The document requests personal identifying information including driver's license or state identification card number, date of birth, race, and sex from the applicant. The form accommodates various types of requesters including HR personnel, contractors, visitors, volunteers, and agency representatives. Applicants must authorize MDOC to conduct criminal history checks and, for employment purposes, motor vehicle operator license record checks to determine eligibility to enter secure facility areas and operate vehicles while conducting Department business.
The LEIN request form includes sections for MDOC personnel to document clearance status, note the number of convictions if applicable, and provide optional comments regarding the background check results. The form requires both applicant signature and date, as well as completion and clearance documentation by MDOC staff. This administrative document serves as a prerequisite screening tool for the Woodland Correctional Facility mechanical underground project, ensuring that all personnel with access to the facility meet security and safety requirements established by the Michigan Department of Corrections.
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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: Woodland C.F. - Site Mechanical Underground
File # 472/23129.KMM
File details come from the government source that posted it. Updated .