LEIN Request REV 09-2019.pdf
PDF 174 KB Posted
- Solicitation number
- RFQ - 171 - 230000000144
- Issued by
- Ionia County, Michigan
About this file
This document is a LEIN Request form from the Michigan Department of Corrections (MDOC). It is used to conduct a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for individuals seeking to enter the secure perimeter or property of an MDOC facility to perform work, visit, or meet with offenders. The form requires the individual's personal information, such as name, address, date of birth, driver's license or state ID number, race, and sex. The individual must sign the form to authorize the MDOC to conduct the LEIN check and, if applicable, to check the individual's motor vehicle operator's license record.
The related state and local contract opportunity is for the Carson City Correctional Facility's Pavement Improvements project, designated as 472/22100.TYC. The project is located in Ionia County, Michigan. The bid submission instructions require that all questions be emailed to the project engineer, and that bid attachments must be uploaded to the SIGMA VSS system. The deadline for bid submissions is 2:00 p.m., and emailed submissions may be accepted on a case-by-case basis with prior approval from the MDOC Office of Design and Construction.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1 22100.pdf | ||
| 472_22100 Plans.pdf | ||
| Addendum 2 22100.pdf | ||
| 472_22100 Specifications.pdf | ||
| DTMB-0415 Advertisement - Carson City.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: Carson City Pavement Improvements File : 472/22100.TYC
File details come from the government source that posted it. Updated .