LEIN Request 472-24055.DPL.pdf
PDF 173 KB Posted
- Solicitation number
- RFQ 171 260000000466 3
- Issued by
- Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request form from the Michigan Department of Corrections (MDOC) used to conduct criminal history checks for individuals seeking access to secure facilities. The form is associated with a project to replace the smoke purge system at an MDOC facility, identified as File #472/24055.DPL. The document requests personal identification information including driver's license or state identification number, date of birth, race, and sex from the individual subject to the background check. The requestor must indicate their role, whether as HR personnel, contractor, visitor, volunteer, or other representative, and confirm whether they will be entering the secure perimeter or property of an MDOC facility.
The LEIN request requires authorization from the individual to allow MDOC to conduct a criminal history check and, for employment purposes, to review motor vehicle operator license records to determine eligibility to operate vehicles during Department business. The form includes completion and clearance sections for MDOC personnel to document whether the LEIN check was completed and whether the individual was cleared for facility access. The form does not specify pricing, set-asides, or funding information, as it functions as an administrative screening tool rather than a procurement or contract document.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: Replace Smoke Purge System File # 472/24055.DPL
File details come from the government source that posted it. Updated .