LEIN Request REV 04-2018.pdf
PDF 24 KB Posted
- Solicitation number
- RFQ 171 190000000639 3
- Issued by
- Baraga County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for vendor and contractor criminal history clearance. The form is required for individuals seeking to enter MDOC facilities in connection with work or vendor activities. The specific project referenced is the Baraga Correctional Facility Propane Plant/Repair of the Back-Up Fuel System Blender (File #472/19087.RAA). Vendors and contractors must complete the form by providing personal identification information including driver's license or state identification card number, date of birth, race, and sex to enable MDOC to conduct the necessary criminal background check prior to facility access.
The form serves as authorization for MDOC to perform a criminal history check through the Michigan Law Enforcement Information Network and indicates whether the applicant has been cleared for facility entry. Applicants are directed to www.michigan.gov/ichat to obtain copies of their Michigan criminal history records, which requires payment of an applicable fee. The form includes sections for staff use only, documenting who requested the LEIN check, who performed the check, clearance status, and completion details with staff initials and date. No pricing terms, contract amounts, or renewal options are specified in this clearance documentation.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: Baraga Correctional Facility - Propane Plant/Repair of the Back-Up Fuel System Blender File # 472/19087.RAA
File details come from the government source that posted it. Updated .