Free adverse action notice 30
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[Applicant’s name and address]

Application for Employment at [EMPLOYER]

Dear [Applicant’s Name]:
I am writing regarding your recent application for employment with [EMPLOYER]. As
you will recall on [Date], you were issued an offer of employment conditioned on successful
completion of, among other things, a satisfactory background check. Previously, you were
provided with a copy of the background generated by [BACKGROUND SERVICE] as part of
that process.
Unfortunately, due to information provided in that report, [EMPLOYER] is unable to
offer you employment. [If the reason for rejection is criminal history information: A
criminal conviction contained in the report was at least part of the reason for the rejection of your
Because you have been rejected based on information contained in the background
report, the Fair Credit Reporting Act entitles you to receive a copy of this report from
[BACKGROUND SERVICE] within 60 days. You also