Sample Adverse Action Letter Form printable pdf download

Sample Adverse Action Letter Form

SAMPLE ADVERSE ACTION LETTER

Put on Your Company Letterhead

This is being provided for informational purposes only, and not as legal advice. As the employer

or user of consumer reports, it is your responsibility to ensure compliance with all of the relevant

federal, state and local laws governing this area, including, but not limited to, the FCRA. We

strongly recommend that prior to use, you consult with your own attorney.

Date

Applicant Name

Address

City/State/Zip Code

Dear [Applicant Name],

We regret to inform you that based on our hiring criteria, we are unable to consider you

further for an employment opportunity with our organization. This decision was made in

part from the information we received from _____________________, our employment

screening vendor. _____________________ does not make these decisions and is

unable to provide you with the specific reasons for them.

In accordance with the Fair Credit Reporting Act, you have previously received a copy

of your report and a copy of your consumer rights under the Act. You also have the right

to obtain a free copy of your report within 60 days of the receipt of this letter by

contacting _____________________ at the address and telephone number listed

below. Please refer to these documents if you have further questions. You have the

right to dispute the accuracy or completeness of the information contained in your report

by contacting _____________________:

_____________________

Any dispute regarding the information on your report must be resolved with

_____________________.

Thank you for your interest in employment with our organization.

Sincerely,

Your Name

Your Title

Sample Adverse Action Letter Form