You have requested to obtain a Motor Vehicle Report

(driving record) from the

STATE OF WASHINGTON

Step 1. Please print this out.

Step 2. Fill out the form leaving only the agent line blank.

Step 3. The EMPLOYER MUST SIGN AND DATE THE FORM.

Step 4. Have the APPLICANT SIGN AND DATE the form.

Step 5. Fax the completed form to I-NEX Solutions, Inc. at

fax (813) 968-2195

Step 6. The records can NOT be searched until this form is received by I-NEX.

Form on next page

Account No.________________

WASHINGTON FORM E

REQUEST FOR ABSTRACT OF DRIVING RECORD

AGENTS FOR EMPLOYERS

An abstract of driving record must be obtained through the Department of Licensing. The Department will not provide a driving record unless the form is signed by the employer and the employee/prospective employee.

EMPLOYER

EMPLOYER:________________________________________________

STREET ADDRESS:__________________________________________

CITY:__________________________ STATE:________ ZIP:_________

I hereby certify that this company is an employer or prospective employer of the named individual and that the abstract of record shall be used exclusively to determine whether the named individual should be employed to operate a commercial vehicle or school bus, and that no information contained therein shall be divulged, sold, assigned, or otherwise transferred to any third person or party. Commercial vehicle means any vehicle the principal use of which is the transportation of commodities, merchandise, produce, freight, animals, or passengers for hire. The information contained in the abstract of driver record obtained from the Department of Licensing shall be used in accordance with requirements and in no way violates the provision of RCW 46.52.130.

____________________________________is an agent of the employer and is authorized to obtain the abstract of record on the employer’s behalf.

_______________________________________________ ___________________

Employer signature and title Date

EMPLOYEE/PROSPECTIVE EMPLOYEE

NAME (Last, First, Middle):______________________________________

WASHINGTON DRIVER’S LICENSE #:___________________________

DATE OF BIRTH (Month, Day, Year):_____________________________

I hereby authorize the Department of Licensing to forward my driving record to the above agent for the employer/prospective employer.

_____________________________________________ ____________________

Employee /prospective employee signature Date

(REV.-2 2/02)