LEIN Request Central.pdf
PDF 123 KB Posted
- Solicitation number
- RFQ-171-250000000336-1
- Issued by
- Gogebic County, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Law Enforcement Information Network (LEIN) Request form for a Wi-Fi Cabling Infrastructure project at the Central Michigan Correctional Facility, identified by File #472/17032.RWG. The form is a standard criminal history check request used to authorize and verify an individual's ability to enter secure MDOC facility perimeters or properties, with the specific intent of performing work, visiting, meeting with, or working with MDOC offenders.
The document requires detailed personal identification information, including name, address, date of birth, sex, race, and either a driver's license or state ID number. The individual must authorize a criminal background check and, for employment purposes, grant permission for the MDOC to review their motor vehicle operator license record. The form is part of the standard security screening process for contractors, visitors, volunteers, or other personnel seeking access to MDOC facilities, ensuring comprehensive background verification before granting entry to secure correctional environments.
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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: Central MI CF -Wi-Fi Cabling Infrastructure.
File # 472/17032.RWG
File details come from the government source that posted it. Updated .