LEIN Request.pdf
PDF 30 KB Posted
- Solicitation number
- RFQ-171-180000000728-2
- Issued by
- Mackinac County, Michigan
About this file
This is a Michigan Department of Corrections (MDOC) Vendor/Contractor LEIN Request form (CAJ-1037) associated with the E.C. Brooks Correctional Facility A/C Repair/Replacement project (File #472/18181.GAG). The form is used to conduct criminal history checks through the Michigan Law Enforcement Information Network (LEIN) for vendors and contractors who need to access MDOC facilities. The document requires personal information including name, address, date of birth, sex, race, and either a driver's license number or state ID number for background check purposes.
The form includes sections for staff use, requiring documentation of the reason for the LEIN check, staff requesting the check, who performed the check, and whether the check was cleared. If the check is not cleared, applicants can obtain their Michigan criminal history through www.michigan.gov/ichat for a fee. The form requires the applicant's signature authorizing MDOC to conduct the criminal history check for facility access approval.
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 04/18
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 is needed to complete this LEIN. Also needed are your date-of-birth, race and sex. Potential entry into MDOC facilities require that this LEIN check be completed and cleared.
Profession Vendor Contractor
Last Name (Please Print) 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 Michigan Department of Corrections to conduct a criminal history check, so that I may be approved to visit/meet with persons confined in a Michigan Department of Corrections facility.
Signature Date
Staff Use Only
Reason for LEIN Check
Staff requesting LEIN Check
LEIN Checked by
LEIN Clear Yes No, You may obtain a copy of your Michigan criminal history at www.michigan.gov/ichat. There is a fee for this service.
LEIN Check completed by Initials Date http://www.michigan.gov/ichat hallt2 Text Box Facility/Project Name: E.C. Brooks Correctional Facility - A/C Repair/Replacement File # 472/18181.GAG
File details come from the government source that posted it. Updated .