LEIN Request REV 09-2019 (with project header).pdf
PDF 136 KB Posted
- Solicitation number
- RFQ 171 240000000567 7
- Issued by
- Livingston County, Michigan
About this file
This is a LEIN (Michigan Law Enforcement Information Network) Request form issued by the Michigan Department of Corrections (MDOC) for conducting criminal history checks on individuals seeking access to secure perimeter facilities. The form applies to employment candidates, contractors, visitors, and volunteers requiring entry to MDOC facilities to perform work, conduct visits, or interact with offenders. The specific project referenced is the Newberry Correctional Facility Electrical Infrastructure Assessment (File #472/23312.LWM). The form requires personal identification information including driver's license or state identification number, date of birth, race, and sex to facilitate the background check process.
The LEIN request form serves as a prerequisite screening document with no pricing terms, set-asides, or contractual renewal options applicable. Completion of the criminal history check is mandatory for access approval to MDOC secure facilities. For MDOC HR and employment purposes, the form includes provisions for motor vehicle operator license record checks to determine eligibility for operating vehicles during Department business. The form indicates whether the background check has been cleared, with an optional comment section for conviction records if applicable to employment determinations.
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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: Newberry Correctional Facility - Electrical Infrastructure Assessment File # 472/23312.LWM
File details come from the government source that posted it. Updated .