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2. STATUTORY AUTHORITY

   Section 4 of the Act (MCL 28.214) provides that the Fire Chief of an organized fire department, or his or her designee, may request and receive LEIN information through a law enforcement agency for the following purpose.

   A. A pre-employment criminal convictions history (purpose code "E" only) check.

   B. A pre-employment driving record check.

   C. Vehicle registration information for vehicles involved in a fire or a hazardous materials incident. 

   This request will be forwarded to Lenawee County Central Dispatch via email.

4. Date:*
   Date:
6. First Name*
7. Middle Name
8. Last Name*
10. D.O.B.
    D.O.B.
11. Driver's License Number*
12. State*
16. Chief or Designee Making Request:*
18. Phone Number:*
20. Fire Department:*
22. Email*
26. Return Date:
28. Driving Record Results:
29. Acceptable:
30. Not Acceptable
34. Criminal History Results:
35. No History
36. Prior History
40. Any questions contact Lt. Perdue at 517-264-5373
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field