LEIN Request REV 09-2019 (with project header) - St. Louis CF.pdf
PDF 136 KB Posted
- Solicitation number
- RFQ-171-250000000555-2
- Issued by
- Gogebic County, Michigan
About this file
This document is a Law Enforcement Information Network (LEIN) Request form issued by the Michigan Department of Corrections (MDOC) for the Statewide Perimeter Fence Repair/Replacement project at St. Louis Correctional Facility, identified by file number 472/24052.JGH. The form is a standard criminal history check request used to authorize and process background screening for individuals seeking to enter secure MDOC facility perimeters, including contractors, visitors, volunteers, and other personnel who may interact with or work near offenders.
The form requires detailed personal identification information such as full name, address, date of birth, sex, race, and either a driver's license or state ID number. The individual must authorize MDOC to conduct a criminal history check and potentially review their motor vehicle operator license record. The form includes checkboxes for various entry purposes and provides spaces for MDOC personnel to record LEIN completion status, clearance, and the number of criminal convictions. This document is part of MDOC's standard security protocol for managing access to correctional facilities and ensuring the safety of personnel and offenders.
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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 Fence Repair/Replacement - St. Louis Correctional Facility File # 472/24052.JGH
File details come from the government source that posted it. Updated .