Form 1

PRE-ADVERSE ACTION DISCLOSURE

Date

Applicant/Employee Name
Address
City, State, Zip Code

Dear Applicant/Employee Name:

In connection with your application for [employment][promotion][other] with

Company Name (the “Company”), you authorized the Company to perform a
background check on you, using either internal resources or an outside
agency.

We are currently reviewing the investigative consumer and consumer credit

reports we received and may decide to eliminate you from further
consideration for [employment][promotion][other] based, in whole or in part,
on the information contained in the reports. Enclosed is a copy of the
investigative consumer and consumer credit reports, together with “A
Summary of Your Rights Under the Fair Credit Reporting Act” as required by
federal law.

(Optional) The Company’s policy is to give a[n] [applicant][current

employee] [number] [days][weeks][months] to review the information
contained in the report before a final decision is made. If, within this time
frame, you can prove that the information contained in the report is
inaccurate or incomplete, please let us know and we will review the corrected
information before making a final employment assessment. If we do not hear
from you within this time, our tentative decision will become final and [you
will not be hired] [your employment will be terminated].

This letter has been sent to you in compliance with the Fair Credit Reporting
Act.

Sincerely,

______________________
Your Name
Title

Enclosures (Number)

Adverse Action Letters 1

 Form 2

NOTICE OF ADVERSE ACTION

Date

Applicant/Employee Name
Address
City, State, Zip Code

Dear Applicant/Employee Name:

In connection with your application for [employment][promotion][other]with

Company Name (the “Company”), you authorized the Company to perform a
background check, either with internal resources or by using an outside
agency. The Company notified you by letter dated Month Day, Year of its
preliminary decision to eliminate you from further consideration for
[employment][promotion][other]based wholly or partially on the information
contained in the report[s] [and gave you [number] days to review the report
and provide corrected or complete information]. [You did not provide us with
a written response within that time frame][The additional or corrected
information that you provided did not change our employment assessment].

This letter serves as notification that we have decided not to [employ]

[promote][other] you based wholly or partially on information contained in
the report[s].

We have enclosed a copy of the report, together with a copy of “A Summary

of Your Rights Under the Fair Credit Reporting Act.”

The report was provided by:

Credit Reporting Company Name

Address
City, State Zip Code
Phone Number

Credit Reporting Company Name did not make the decision to deny you
[employment][promotion][other], and they cannot explain to you why your
application was denied.

Under the Fair Credit Reporting Act, you can obtain the information in your
report by contacting Credit Reporting Company Name. This information will
be provided for free if you contact Credit Reporting Company Name within 60
days of the date you received this letter. You have the right to challenge
Credit Reporting Company Name directly about the accuracy and
completeness of any information in the report.

Adverse Action Letters 2

 Form 2

Thank you for your interest in employment with our organization.

Sincerely,

______________________
Your Name
Title

Enclosures (Number)

Adverse Action Letters 3

 Form 3

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy,
fairness, and privacy of information in the files of consumer reporting
agencies. There are many types of consumer reporting agencies,
including credit bureaus and specialty agencies (such as agencies that
sell information about check writing histories, medical records, and
rental history records). Here is a summary of your major rights under
the FCRA. For more information, including information about
additional rights, go to www.ftc.gov/credit or write to:
Consumer Response Center, Room 130-A, Federal Trade
Commission, 600 Pennsylvania Ave. N.W., Washington, D.C.
20580.

1. You must be told if information in your file has been used

against you. Anyone who uses a credit report or another type of
consumer report to deny your application for credit, insurance, or
employment – or to take another adverse action against you – must
tell you, and must give you the name, address, and phone number
of the agency that provided the information.

2. You have the right to know what is in your file. You may
request and obtain all the information about you in the files of a
consumer reporting agency (your “file disclosure”). You will be
required to provide proper identification, which may include your
Social Security number. In many cases, the disclosure will be free.
You are entitled to a free file disclosure if:

 a person has taken adverse action against you because of

information in your credit report;

 you are the victim of identity theft and place a fraud alert in your
file;

 your file contains inaccurate information as a result of fraud;

 you are on public assistance;

 you are unemployed but expect to apply for employment within

60 days.

In addition, by September 2005 all consumers will be entitled to one

free disclosure every 12 months upon request from each nationwide
credit bureau and from nationwide specialty consumer reporting
agencies. See www.ftc.gov/credit for additional information.

Adverse Action Letters 4

 Form 3

3. You have the right to ask for a credit score. Credit scores are
numerical summaries of your credit-worthiness based on
information from credit bureaus. You may request a credit score
from consumer reporting agencies that create scores or distribute
scores used in residential real property loans, but you will have to
pay for it. In some mortgage transactions, you will receive credit
score information for free from the mortgage lender.

4. You have the right to dispute incomplete or inaccurate

information. If you identify information in your file that is
incomplete or inaccurate, and report it to the consumer reporting
agency, the agency must investigate unless your dispute is
frivolous. See www.ftc.gov/credit for an explanation of dispute
procedures.

5. Consumer reporting agencies must correct or delete

inaccurate, incomplete, or unverifiable information.
Inaccurate, incomplete or unverifiable information must be removed
or corrected, usually within 30 days. However, a consumer reporting
agency may continue to report information it has verified as
accurate.

6. Consumer reporting agencies may not report outdated

negative information. In most cases, a consumer reporting
agency may not report negative information that is more than
seven years old, or bankruptcies that are more than ten years old.

7. Access to your file is limited. A consumer reporting agency may

provide information about you only to people with a valid need –
usually to consider an application with a creditor, insurer, employer,
landlord, or other business. The FCRA specifies those with a valid
need for access.

8. You must give your consent for reports to be provided to

employers. A consumer reporting agency may not give out
information about you to your employer, or a potential employer,
without your written consent given to the employer. Written consent
generally is not required in the trucking industry. For more
information, go to www.ftc.gov/credit.

9. You may limit “prescreened” offers of credit and insurance

you get based on information in your credit report.
Unsolicited “prescreened” offers for credit and insurance must
include a toll-free phone number you can call if you choose to
remove your name and address from the lists these offers are based

Adverse Action Letters 5

 Form 3

on. You may opt-out with the nationwide credit bureaus at 1-888-
OPTOUT (1-888-567-8688).

10. You may seek damages from violators. If a consumer

reporting agency, or, in some cases, a user of consumer reports or a
furnisher of information to a consumer reporting agency violates the
FCRA, you may be able to sue in state or federal court.
11. Identity theft victims and active duty military personnel
have additional rights. For more information, visit
www.ftc.gov/credit.

States may enforce the FCRA, and many states have their own
consumer reporting laws. In some cases, you may have more
rights under state law. For more information, contact your
state or local consumer protection agency or your state
Attorney General. Federal enforcers are:

TYPE OF BUSINESS CONTACT

Consumer reporting agencies, creditors and others Federal Trade Commission: Consumer Response
not listed below Center – FCRA Washington, DC 20580; 1-877-382-
4357
Office of the Comptroller of the Currency,
Compliance Management, Mail Stop 6-6
National banks, federal branches/agencies of
Washington, DC; 20219
foreign banks (word “National” or initials “N.A.”
800-613-6743
appear in or after bank's name)
Federal Reserve Consumer Help (FRCH)
P O Box 1200
Federal Reserve System member banks (except
Minneapolis, MN 55480
national banks, and federal branches/agencies of
Telephone: 888-851-1920
foreign banks)
Website Address:
www.federalreserveconsumerhelp.gov
Email Address: [email protected]

Savings associations and federally chartered Office of Thrift Supervision Consumer, Complaints
savings banks (word “Federal” or initials “F.S.B.” Washington, DC 20552; 800-842-6929
appear in federal institution's name)

Federal credit unions (words “Federal Credit Union” National Credit Union Administration 1775 Duke
appear in institution's name) Street Alexandria, VA 22314; 703-519-4600

State-chartered banks that are not members of the Federal Deposit Insurance Corporation, Consumer
Federal Reserve System Response Center, 2345 Grand Avenue, Suite 100
Kansas City, Missouri 64108-2638; 1-877-275-3342

Air, surface, or rail common carriers regulated by Department of Transportation , Office of Financial
former Civil Aeronautics Board or Interstate Management Washington, DC 20590; 202-366-1306
Commerce Commission

Activities subject to the Packers and Stockyards Department of Agriculture, Office of Deputy
Act, 1921 Administrator – GIPSA Washington, DC 20250; 202-
720-7051

Adverse Action Letters 6

 Form 3

Adverse Action Letters 7