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DISCLAIMER: Please note, while this template is compliant with the federal Fair Credit Reporting Act, GoodHire cannot
guarantee it meets the requirements of every state and local law. Newly enacted ban the box laws may require additional
information be provided in your adverse action notices. This document is for informational purposes only and does not
constitute legal advice. Please consult your attorney in order to ensure your adverse action notices comply with the
requirements of your and your candidates’ jurisdictions.

[Date]

Personal and Confidential
[Applicant name and address]

Dear [Applicant]:
In reference to your application for employment, we regret to inform you that we are unable to
further consider you for employment at this time. Our decision is based, in part, on information
obtained through the Consumer Reporting Agency identified below.
The Consumer Reporting Agency did not make the adverse decision, and is unable to explain
why the decision was made.
You have the