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Basic form © James R. McDade (version 09-17-02) 209-667-2300 NOTICE OF INTENDED ADVERSE EMPLOYMENT ACTION Note: Employers use this form to notify a prospective employee or current employee that an adverse employment action will be taken as a result of information disclosed in a consumer report. (Delete this note prior to use.)Date: ________________________Prospective or Current EmployeeAddressCity, State, ZipDear _________________:Based on information contained in the attached Consumer Report, the above-identified employer has determined that it will [not hire you for the position you sought] [terminate your employment] .The following “Reporting Agency” provided the report: [Name of Consumer Reporting Agency, Investigator, or Reporting Entity][Address][Phone][Toll Free Phone Number, if Reporting Agency is national] The Reporting Agency did not make the decision to take the employment action described above. Therefore, the Reporting Agency will be unable to provide to you the specific reasons why this employment action is being taken.Pursuant to federal law and California Civil Code §1785.20, you have the right to request and obtain within 60 days a free copy of the credit report or investigative (background check) report directly from the Reporting Agency identified above, and from any other consumer credit reporting agency that compiles and maintains files on consumers on a nationwide basis. You must directly contact the Report Agency above to obtain a copy of the report.You also have a right under federal law and pursuant to California Civil Code §1785.16 and §1786.24 (whichever is applicable) to dispute the accuracy or completeness of any information contained in the report provided by the Reporting Agency. You must directly contact the Reporting Agency as soon as possible to correct any information in the report that you believe is incorrect. However, for employment related purposes, please provide us within 5 days any information that would dispute or correct the report provided by the Reporting Agency as soon as possible. We are not obligated to investigate nor correct any information contained in the consumer report provided by the Reporting Agency, but we will review the information you provide us. The adverse action proposed above will become final five (5) days after this notice is provided to you.Please find enclosed a copy of the credit report and/or investigation (background check) report we received from the Reporting Agency. Also please find enclosed a copy of “A Summary Of Your Rights Under The Fair Credit Reporting Act”.Sincerely,Employer’s NameBy: ______________________________ ______________________Employer’s Representative Title