LEIN Request REV 09-2019 (with project header).pdf
PDF 160 KB Posted
- Solicitation number
- RFQ - 171 - 240000000186
- Issued by
- Lenawee County, Michigan
About this file
The provided document is a LEIN Request form from the Michigan Department of Corrections (MDOC). This form is used to conduct a criminal history check through the Michigan Law Enforcement Information Network (LEIN) for individuals seeking to enter the secure perimeter/property of an MDOC 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. The individual must sign the form to authorize the MDOC to conduct the criminal history check and, if applicable, check the individual's motor vehicle operator license record.
The related state and local contract opportunity is for the GHCF - BLDG 200 Boiler Replacement project in Lenawee County, Michigan. The project involves the replacement of boilers at the specified location. Interested bidders must upload their attachments to the SIGMA VSS system, as hard copies will not be accepted. Bidders are instructed to email questions to the designated contact and to notify the Office of Design and Construction if they experience any issues with the SIGMA VSS system.
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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: ________________________________ File # 472/_______.____
File details come from the government source that posted it. Updated .