LEIN Request REV 09-2019.pdf
PDF 160 KB Posted
- Solicitation number
- RFQ - 171 - 200000000144
- Issued by
- Delta County, Menominee City, Michigan
About this file
This document is a LEIN (Law Enforcement Information Network) Request form from the Michigan Department of Corrections. The form is used to conduct a criminal history check for individuals who need to enter the secure perimeter or property of a Michigan Department of Corrections facility to perform work, visit, meet with, or work with MDOC offenders. The form requires the individual's personal information, such as name, address, date of birth, sex, race, and driver's license or state ID number, as well as their authorization for the MDOC to conduct the criminal history check and, if for employment purposes, check their motor vehicle operator's license record.
The related state and local contract opportunity is for the Marquette Branch Prison Various Roof Restores project, located in Delta County and Menominee City, Michigan. The project involves roof restoration work, and interested parties are encouraged to verify any pre-bid meeting details and check for any last-minute addenda on the SIGMA website. Bid attachments must be uploaded to the SIGMA VSS system, and vendors are advised to keep the project manager informed of any SIGMA VSS issues and include their SIGMA ticket number when communicating with the office.
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Other files
| File | Type | Posted |
|---|---|---|
| Admin 472-19456.JBB (Advertisment).pdf | ||
| Admin 472-19456 JBB Bid Plan.pdf | ||
| 472-19456.JBB Admin Spec.pdf |
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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: _Marquette Branch Prison Various Roof Restoring - Admin-Brooks Roof File # 472/19456.JBB kdillinger Typewritten Text kdillinger Typewritten Text
File details come from the government source that posted it. Updated .