Free adverse action notice 06Free adverse action notice 06
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SAMPLE PRE-ADVERSE ACTION NOTIFICATION

Date
Dear _______________________:
On [Date] , you authorized [Employer] to obtain consumer reports and/or investigative consumer reports
about you from a consumer reporting agency. The Company is considering taking action in whole or in part
based on information in such report(s). Enclosed please find (1) a copy of the report we obtained from
Occuscreen, LLC, 805 Broadway Street, Suite 215 Vancouver, WA 98660, (2) a summary of your rights
under the Fair Credit Reporting Act, and if applicable, (3) Article 23-A of the New York Correction Law, (4) A
Summary of Your Rights Under New Jersey Law, (5) A Summary of Your Rights Under Washington Law,
and (6) a copy of the Company’s Background Check Policy and Information Concerning the Process for
Correcting a Criminal Record in Massachusetts.
We will evaluate the information in your report on an individualized case-by-case basis in accordance with
the law and EEOC guidance. If you believe that there is