LEIN Request REV 09-2019 (with project header) - Kinross CF.pdf
PDF 130 KB Posted
- Solicitation number
- RFQ 171 250000000175 2
- Issued by
- Cass County, Michigan
About this file
This is a Criminal History Check Request Form (LEIN Request CAJ-1037, Revised 09/2019) issued by the Michigan Department of Corrections for the Kinross Correctional Facility Statewide Perimeter Repair/Replacement project (File #472/24052.JGH). The form is used to initiate a criminal history background check through the Michigan Law Enforcement Information Network (LEIN) for individuals requiring access to secure perimeters or properties of MDOC facilities. Individuals must provide personal identification information including driver's license or state identification number, date of birth, race, and sex. The form accommodates multiple categories of individuals including employment candidates, contractors, visitors, volunteers, and representatives. Respondents must indicate whether they will be entering the secure perimeter or property of an MDOC facility and authorize the Department to conduct criminal history checks as a condition of facility access approval.
The form includes provisions for MDOC Human Resources or Employment purposes that allow additional authorization for motor vehicle operator license record checks to determine eligibility to operate vehicles while conducting Department business. Completed LEIN requests must be processed and cleared by authorized MDOC personnel, with notation of clearance status and any conviction records or relevant comments. This administrative document serves as a gatekeeping mechanism to ensure all individuals accessing MDOC facilities meet security and background requirements prior to entry or engagement with facility operations and offender populations.
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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 - Kinross Correctional Facility File # 472/24052.JGH
File details come from the government source that posted it. Updated .