LEIN Request From 17466.pdf
PDF 171 KB Posted
- Solicitation number
- RFQ 171 200000000124 3
- Issued by
- Benzie County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request Form CAJ-1037 issued by the Michigan Department of Corrections (MDOC) for criminal history background checks. The form is associated with the Lakeland Correctional Facility (LCF) Watermain & Sanitary Sewer project, identified under File # 472/17466.CDP. The LEIN request is designed to screen individuals who require access to the secure perimeter or property of an MDOC facility, including employment candidates, contractors, visitors, volunteers, and other agency representatives. Requesters must provide personal identification information including driver's license or state identification card number, date of birth, race, and sex to complete the criminal history check. The form indicates whether the individual is seeking entry to the secure perimeter and requires authorization for the MDOC to conduct the background check.
The form includes optional authorization for motor vehicle operator license record checks for MDOC employment and human resources purposes. Upon completion of the LEIN check, the form documents whether the individual cleared the background review, with space for conviction counts and optional comments. The document serves as both a request and clearance record, with signature lines for the applicant, LEIN completion personnel, and clearance status notation. This administrative form is a prerequisite security requirement for the Lakeland facility project involving watermain and sanitary sewer work.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Plan Part C 17466.pdf | ||
| Plan Part A 17466.pdf | ||
| Addendum 1 17466.pdf | ||
| Addendum 2 17466.pdf | ||
| Advertisement 17466.pdf | ||
| Specifications A 17466.pdf | ||
| Plan Part B 17466.pdf | ||
| Specifications B 17466.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):
hallt2 Text Box Facility/Project Name: Lakeland (LCF) Watermain & Sanitary Sewer File # 472/17466.CDP
File details come from the government source that posted it. Updated .