LEIN Request REV 09-2019 (with project header) - Alger CF.pdf
PDF 130 KB Posted
- Solicitation number
- RFQ 171 250000000177 2
- Issued by
- Alger County, Michigan
About this file
This is a LEIN (Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for criminal history background checks. The form, designated CAJ-1037 and revised in September 2019, is associated with the MDOC Statewide Perimeter Repair/Replacement project at Alger Correctional Facility (File #472/24052.JGH). The document serves as a pre-access screening tool for individuals requiring entry to secure perimeter or property of MDOC facilities, including employment applicants, contractors, visitors, volunteers, and other agency representatives. The form collects personal identification information including full name, address, date of birth, sex, and race, along with driver's license or state identification card numbers to facilitate the criminal history background check process.
The form authorizes MDOC to conduct comprehensive criminal history checks through the Michigan Law Enforcement Information Network and permits the Department to review motor vehicle operator license records for employees and HR purposes to determine eligibility for operating vehicles during Department business. Completion and clearance of the LEIN request are documented through signature lines for both the applicant and MDOC personnel conducting the background check, with fields for recording conviction history and optional comments. This screening mechanism is a mandatory prerequisite for any individual seeking access to MDOC facilities or engagement with offenders in connection with the Alger Correctional Facility perimeter repair and replacement project.
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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: MDOC Statewide Perimeter Repair/Replacement - Alger Correctional Facility File # 472/24052.JGH
File details come from the government source that posted it. Updated .