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Insurance / Insurance Claims / Employment / Subscriber Certification of Use

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

I certify to the Michigan Department of State that abstracts of driving records obtained from Laborchex, Inc. shall be used exclusively for the purpose of employment.

I further certify that the company designated below further agrees that the information received will be used only in connection with the business purpose specified under this agreement. Additionally, designated company agrees that the information furnished under this Agreement will not be used to engage in any illegal activity, or in any method, act, or practice, which is unfair or deceptive in the solicitation or advertisement of goods, services, or real estate to Michigan or other consumers. Designated company further agrees not to use the information furnished under this Agreement to compile other records for resale or to store, in any shape or form, any record or data received from the Michigan Department of State any longer than required by law, and to destroy or otherwise dispose of the data at the earliest time permitted by law.