LEIN Request From 19116.pdf
PDF 165 KB Posted
- Solicitation number
- RFQ-171-200000000095-3
- Issued by
- Barry County, Michigan
About this file
This is a Law Enforcement Information Network (LEIN) Request form (CAJ-1037) from the Michigan Department of Corrections (MDOC) associated with the Lakeland (LCF) Gun Range facility project (#472/19116.CDP). The form is used to conduct criminal history checks for individuals who need to enter MDOC facilities, whether as employees, contractors, visitors, or volunteers. The form requires personal identification information including driver's license or state ID number, date of birth, race, and sex to complete the background check.
The form includes authorization for MDOC to conduct criminal history checks for facility access and, specifically for HR/Employment purposes, authorization to check motor vehicle operator license records. The document includes sections for recording whether the LEIN check was cleared and the number of convictions for employment purposes. The form must be signed and dated by the applicant, with final verification completed by MDOC personnel who conduct the LEIN check.
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Other files
| File | Type | Posted |
|---|---|---|
| Advertisement 19116.pdf | ||
| PreBid SignIn 19116.pdf | ||
| Specs 19116.pdf | ||
| Plans 19116.pdf | ||
| Addendum 1 19116.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) Gun Range File # 472/19116.CDP
File details come from the government source that posted it. Updated .