LEIN Request REV 04-2018 17471.pdf
PDF 24 KB Posted
- Solicitation number
- RFQ-171-190000000151-3
- Issued by
- Gogebic County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) for a vendor/contractor criminal history check related to the St. Louis Correctional Facility - Housing Unit Shower Renovations project, identified as File #472/17471.JAG. The form is designed to facilitate a criminal background screening for individuals seeking to enter MDOC facilities, requiring submission of personal identification details including driver's license or state ID number, date of birth, race, sex, and a signed authorization for a criminal history check.
The form does not provide specific pricing, contract terms, or detailed project specifications beyond identifying the renovation location as the St. Louis Correctional Facility's housing unit shower area. The LEIN check is a mandatory prerequisite for vendor or contractor access to the facility, with the completed form serving as an authorization for the MDOC to conduct a comprehensive criminal background investigation. Individuals can obtain a copy of their Michigan criminal history through the www.michigan.gov/ichat website, which charges a fee for the service.
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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: St. Louis Correctional Facility - Housing Unit Shower Renovations File # 472/17471.JAG
File details come from the government source that posted it. Updated .