LEIN Request.pdf
PDF 26 KB Posted
- Attached to
- 472/19097. TAP Chippewa CF- HVAC Repairs & Replacements State and local contract opportunity
- Solicitation number
- RFP 171 190000001271 2
- Issued by
- Cass County, Kincheloe CDP, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for vendors and contractors requiring access to MDOC facilities. The form is used to initiate criminal history background checks for individuals who need to visit or meet with persons confined in Michigan Department of Corrections facilities. Applicants must provide personal identification information including driver's license number or state identification card number, social security number, date of birth, race, and sex. At least two of three identification types (driver's license, state ID, or social security number) must be provided to complete the request. The form includes sections for the applicant's professional designation, full name, address, and facility or project name associated with the visit or work assignment.
The LEIN check authorization process requires the applicant's written consent for MDOC to conduct the criminal history background check. Staff members complete designated sections documenting who requested the LEIN check, who conducted it, and the clearance status (yes or no). Applicants who are not cleared may obtain a copy of their Michigan criminal history through www.michigan.gov/ichat, though a fee applies for this service. The form is designated CAJ-1037 REV. 03/15 and includes a file number field referencing 472/ for internal tracking purposes.
View the file
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| 472_19097.TAP Project Statement.pdf | ||
| Chippewa Bldg 200 M Drawings.pdf | ||
| Chippewa Bldg 300 E Drawings.pdf | ||
| Chippewa Bldg 200 E Drawings.pdf | ||
| DMB406 Addendum 1 - URF HVAC Repair and Replacement.pdf | ||
| URF HVAC 3-14-19 PreProposal Attendance.pdf | ||
| URF HVAC 3-14-19 Walkthru Photos 29-56.pdf | ||
| Chippewa Bldg 100 E Drawings.pdf | ||
| PSC Sample Contract.pdf | ||
| 19097_RFP.pdf | ||
| URF HVAC 3-14-19 Walkthru Photos 1-28.pdf | ||
| Chippewa Bldg 100 M Drawings.pdf | ||
| Chippewa Bldg 300 M Drawings.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 .