Sample Pre-Adverse Action Letter Form printable pdf download

Sample Pre-Adverse Action Letter Form

[SAMPLE PRE - ADVERSE ACTION LETTER]

Dear _______:

This notification is being provided to advise you of our intent to take adverse

employment action, e.g., not hire, terminate, etc., against you, based in whole or in part,

upon information contained in a consumer report provided to us by Metrodata Services,

Inc. (“Metrodata”). (a copy of that report is attached for your reference along with a copy

of your rights under the Fair Credit Reporting Act).

If you believe that this report is incomplete or inaccurate, or wish to explain

and/or provide mitigating information, please advise me immediately. You may contact

Metrodata at: (866) 910-6387, and advise them that you dispute the report if you, in fact,

dispute its contents. They will begin an investigation of your dispute. To ensure accurate

communication, have the report in hand when you call them. We will delay taking

adverse action for _____ business days. At the conclusion of that period we will take the

contemplated adverse action. However, that does not affect your rights to dispute the

contents of the report or your file with Metrodata at any time. It is our policy to

individually assess each applicant and your input regarding a criminal record or other

adverse information is welcomed so that we can properly evaluate your situation and

determine whether or not to take the contemplated adverse action.

If you have any questions, please contact my office.

Very truly yours,

Sample Pre-Adverse Action Letter Form