PAR, Inc. has invited me to serve as an examiner for PAR data collection. This may last for the duration of the development period and may be terminated at any time by either party. Any and all results of my involvement in the development of any PAR product is considered proprietary information, as defined below, and PAR, Inc. retains the copyright to this information. In determining my willingness to participate, I may be presented with proprietary information, such as, but not limited to, a description of the work and software development specifics. Should I decide to participate, I acknowledge that I may be exposed to, or have possession and/or knowledge of, PAR, Inc. proprietary information of a technical or non-technical nature. At the end of the project, the data collector/examiner agrees to return any test materials and unused protocols to PAR, Inc.

As follows, the term “Proprietary Information” refers to any and all information of a confidential, proprietary, or secret nature that belongs to PAR, Inc. Such information includes: personnel information, hard copy or electronic copy of information/data derived from PAR, Inc. databases, any information deemed confidential on an ad hoc basis or information associated with its business areas of the commercial development, production, and distribution of psychological instruments or the publication or distribution of psychological publications.

I acknowledge that PAR, Inc.’s proprietary information is a special and unique asset, and I agree at all times before, during my involvement, and thereafter to keep in confidence and trust all such information. I agree that I will not directly or indirectly use any of PAR, Inc.’s proprietary information other than in the course of my involvement as an examiner with PAR, Inc., nor will I directly or indirectly disclose any such proprietary information to any person or entity without the consent of PAR, Inc. Whether I choose to participate or decline to participate, I agree to maintain the confidentiality of these works, improvements, software development/code, copyrighted documents, or inventions produced by me for PAR, Inc. from this point forward.

The undersigned data collector/examiner acknowledges and agrees that the information collected for Psychological Assessment Resources, Inc. (PAR, Inc has been verified as accurate and complete to the best of his/her ability. In addition, the data collector/examiner has made reasonable effort to complete the specific demographic cases that have been reserved and agreed to with PAR’s Data Collection Coordinator. The data collector/ examiner also maintains that no information collected on any participant has been falsified or altered in any way. If a data collector/examiner has reason to suspect that a participant has falsified or altered information in any way, they agree to promptly alert the data collection staff at PAR. The undersigned data collector/examiner acknowledges that they may be asked to attend additional data collection training sessions or to stop collecting data if there is a pattern of invalid cases being submitted. These patterns may include but are not limited to cases that do not meet demographic reservations, participants not meeting eligibility requirements, participants failing validity checks, incorrect or nonstandard test administration, inconsistent or incomplete data, or international data being submitted without prior approval.

The data collector/examiner accepts responsibility for following all organizational requirements when collecting data, including the use of PAR materials at any specific location.

No part of the information contained in or related to the project may be reproduced, redistributed, or transmitted in any form or by any means, electronically or mechanically, without prior written permission of PAR, Inc. Duplicating or reprinting any of these test materials or results is strictly prohibited.

At the end of the project, if applicable, the data collector/examiner agrees to return any test materials and unused protocols to PAR, Inc.

I understand and agree to all aspects of the Nondisclosure Agreement and Integrity and Confidentiality Statement for PAR.

4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

I hereby authorize Psychological Assessment Resources, Inc. (PAR, Inc to make electronic payments via ACH to my bank account. In the event that the ACH is unable to go through (e.g., due to closure or abandonment of an account or inaccurate account information), PAR, Inc. will resume making payments to me with a printed check. I understand I will continue to receive a check while the ACH request is processed, which may take up to 30 days. This authorization is to remain in place until PAR, Inc. has received written notice to terminate or change this authorization.