LEIN Request REV 04-2018.pdf

30 KB Posted

Attached to
File No. 472/17042. TAP-Alger CF-Replace/Repair Propane Plant
Solicitation number
RFQ-171-180000000781-2
Issued by
Alger County, Michigan

About this file

Written by GovTribe AI ·

This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for vendor and contractor criminal history background checks. The form is designed to facilitate criminal history checks for individuals seeking to enter or visit MDOC facilities, requiring detailed personal identification information including full name, date of birth, race, sex, and either a driver's license or state identification number. The document provides a mechanism for MDOC to conduct preliminary screening of potential vendors, contractors, or visitors through a standardized criminal background verification process.

The form authorizes MDOC to perform a comprehensive criminal history check, with staff able to clear or deny access based on the LEIN investigation results. Individuals are informed they can obtain a copy of their Michigan criminal history through the www.michigan.gov/ichat website, which involves a service fee. The document includes sections for staff to document the reason for the LEIN check, track the verification process, and record final clearance status. While no specific contract details or monetary values are presented, the form represents a critical administrative step in vendor and contractor qualification for access to correctional facilities.

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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: ________________________________ File # 472/_______.____

File details come from the government source that posted it. Updated .