LEIN Request REV 04-2018 17471.pdf
PDF 24 KB Posted
- Solicitation number
- RFQ 171 190000000151 3
- Issued by
- Macomb County, Michigan
About this file
This is a Vendor/Contractor LEIN (Law Enforcement Information Network) Request Form issued by the Michigan Department of Corrections (MDOC) for criminal history clearance purposes. The form is required for vendors and contractors seeking approval to visit or meet with individuals confined in MDOC facilities. The request pertains to a specific project: St. Louis Correctional Facility - Housing Unit Shower Renovations (File #472/17471.JAG). The form collects essential identification information from the vendor or contractor, including full name, address, date of birth, sex, race, and either a driver's license number or state identification card number. This LEIN check must be completed and cleared before the vendor or contractor can gain access to MDOC facilities for project-related activities.
The LEIN check is a mandatory security and safety requirement with no pricing terms, set-asides, or contract funding components addressed in this particular document. The form authorizes MDOC to conduct a criminal history background check using the collected personal identification data. Individuals may obtain copies of their Michigan criminal history through www.michigan.gov/ichat for a fee if needed for reference purposes. Upon completion, MDOC staff documents the check results, including whether the clearance was approved or denied, along with staff initials and completion date.
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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 .