LEIN Request.pdf
PDF 26 KB Posted
- Attached to
- 472/16382. TAP Kinross CF - Roof Replacements
- Solicitation number
- RFQ-171-190000000484-3
- Issued by
- Clare County, Michigan
About this file
The document is a Vendor/Contractor LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections, designed to conduct a criminal history check for individuals seeking to visit or meet with persons confined in a Michigan Department of Corrections facility. The form requires detailed personal identification information, including at least two forms of identification such as a driver's license, state ID, or social security number, along with demographic details like date of birth, sex, and race.
The purpose of this form is to facilitate a background screening process for vendors, contractors, or other professionals who need access to correctional facilities. By completing this form and providing authorization, the individual allows the Michigan Department of Corrections to perform a comprehensive criminal history check through the LEIN system. If the LEIN check is not cleared, the individual may obtain a copy of their Michigan criminal history through an online service (www.michigan.gov/ichat) for a fee. The form includes sections for staff to document the reason for the LEIN check and record the results of the background screening.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 472_16382.TAP_Advertisement.pdf | ||
| 472_16382.TAP_Plans_Pt_B.pdf | ||
| Addendum #2.pdf | ||
| 472_16382.TAP_Plans_Pt_A.pdf | ||
| 472_16382.TAP_Specifications.pdf | ||
| Addendum 1 16382.pdf |
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Text version
MICHIGAN DEPARTMENT OF CORRECTIONS
VENDOR/CONTRACTOR LEIN REQUEST
CAJ-1037
REV. 03/15
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 and your Social Security 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 at least two of the following three types of identification:
Driver’s License # State issued by
State ID # State issued by
Social Security #
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: ________________________________ File # 472/_______.____
File details come from the government source that posted it. Updated .