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This Agreement entered into on ______________________, 20__ between Laborchex, Inc., hereinafter referred to as ("Laborchex"), a Mississippi Corporation, and _____________________________, hereinafter referred to as ("Client").

Client certifies that for each driving record it requests, the information contained therein shall be used solely for the purposes of employment and shall provide, to Laborchex, a written authorization signed by the applicant.

In filing this certificate, the company agrees to the following provisions:

1. In the event that a decision is based upon any information supplied to the Client by the Department of Public Safety then, upon request of the applicant, Client will inform the applicant of all information pertinent to the decision. This provision is to be construed as requiring the Client to include specific information included in the applicant's operating record.

2. All information is requested only for the Client's exclusive use. Client will not pass any information included in the motor vehicle report to any other person or company.

3. Any violation of the provisions of this certificate, any other certificates required by the Department of Public Safety or provisions of the Fair Credit Reporting Act, or any other applicable state or federal law will be sufficient grounds for the Department to refuse to issue any additional information on any other driver that Client may request. This administrative action by the Department will not be deemed to supersede any other sanctions prescribed by law, including but not limited to, O.C.G.A. 40-5-2, providing for twelve (12) months in prison or a fine of $1,000.00 or both for violating rules and regulations contained in this certificate.

4. The burden of showing compliance with the provisions of this certificate is at all times on the Client filing this certificate. Upon reasonable notice by the Department, Client must be able to demonstrate such compliance.