LEIN Request Form.pdf
PDF 24 KB Posted
- Solicitation number
- RFQ-171-190000000155-2
- Issued by
- Saginaw County, Flint City, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request Form from the Michigan Department of Corrections (MDOC) for vendor/contractor criminal history checks, specifically associated with the Saginaw Correctional Facility Propane Plant Replace/Repair project (File #472/17438.TYC). The form is used to conduct mandatory background checks for vendors and contractors who need access to 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.
The form includes an authorization section where vendors/contractors must consent to the criminal history check. There is also a staff-use section that tracks the LEIN check process, including fields for the reason for the check, requesting staff member, and verification of whether the check was cleared. If the check is not cleared, applicants are directed to obtain their Michigan criminal history through www.michigan.gov/ichat for a fee.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Design Build Addendum 1.pdf | ||
| Design Build Specifications.pdf | ||
| DTMB-0415 (Design Build Advertisement R10-17).pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: Saginaw Correctional Facility, Propane Plant Replace/ Repair File # 472/17438.TYC
File details come from the government source that posted it. Updated .