Free adverse action notice 24Free adverse action notice 24Free adverse action notice 24
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Sample documents should NOT be construed as legal advice, guidance or counsel. Employers should
consult their own attorney about their compliance responsibilities under the FCRA and applicable state law.
SecurTest, Inc. expressly disclaims any warranties or responsibility or damages associated with or arising
out of information provided. Employers seeking credit reports must provide additional notices pursuant to
state law.

SAMPLE PRE-ADVERSE ACTION NOTIFICATION
Date
NAME
ADDRESS
CITY, ST ZIP
Dear _______________________:
You recently authorized [Employer] (the “Company”) 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) , including the following specific items identified in
the report:
[Identify specific Items.]
Enclosed please find (1) a copy of the report we obtained from SecurTest, Inc., 2001 Drayton Drive,
Tallahassee, FL 3