LEIN Request Form - 472.22366.MNB.pdf
PDF 2 MB Posted
- Solicitation number
- RFQ - 171 - 230000000599
- Issued by
- Lenawee County, Michigan
About this file
The document is a LEIN Request Form from the Michigan Department of Corrections (MDOC). It is used to request a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for individuals who need to access secure MDOC facilities, such as employees, contractors, visitors, and volunteers. The form requires personal information including name, address, date of birth, race, sex, and driver's license or state ID number. The individual must sign the form to authorize the LEIN check and, for MDOC employment purposes, a motor vehicle operator's license record check.
The related state and local contract opportunity is for Gus Harrison Correctional Facility - PA & Paging Upgrades, project number 472/22366.MNB, located in Lenawee County, Michigan. The contract seeks services to perform upgrades to the public address (PA) and paging systems at the facility. Interested bidders must submit questions via email to the designated contact, and proposal attachments must be uploaded to the SIGMA VSS system. The deadline for submissions is 2:00 p.m., and emailed proposals may be accepted on a case-by-case basis with prior approval.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 22366 - DCSpec Rev032022 V13.pdf | ||
| 22366 Advertisement.pdf | ||
| 22366 BID Drawings.pdf | ||
| Addendum 1 Gus Harrison PA Paging Upgrades 472_22366.MNB.pdf |
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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):
mgatt Text Box Facility/Project Name: Gus Harrison Correctional Facility - PA & Paging Upgrades File No: 472/22366.MNB
File details come from the government source that posted it. Updated .