LEIN Request_PHASE II 25082.pdf
PDF 171 KB Posted
- Solicitation number
- RFQ 171 260000000325 1
- Issued by
- Macomb County, Mcbride Village, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history background check purposes related to the Oaks Correctional Facility Emergency Generator, ATS & Primary Switchgear Phase II project (File #472/25082.RLO). The form is required for individuals seeking access to the secure perimeter or property of an MDOC facility to perform work, conduct visits, meet with staff, or interact with offenders. The document requests personal identification information including driver's license or state identification card number, date of birth, race, and sex from the applicant, along with authorization signatures to conduct the criminal history check and, where applicable for MDOC employment purposes, to review motor vehicle operator license records.
The form serves as a gatekeeping mechanism for contractor and visitor access to MDOC facilities and includes fields for MDOC personnel to document LEIN clearance status and any conviction information relevant to employment or facility access determinations. No specific pricing terms, contract amounts, or procurement deadlines are contained within this background check authorization document, as it functions solely as a security screening tool rather than a procurement instrument.
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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: Oaks Correctional Facility - Emergency Generator, ATS & Primary Switchgear - PHASE II File # 472/25082.RLO
File details come from the government source that posted it. Updated .