Fill and Sign the Denial Notice New York State Department of Health Form

{Insert Date} Insert NameInsert AddressInsert City, State, and Zip CodeDear _______ :As you know, during your {Insert Type of Review} process with {Insert Company Name}, you signed an authorization for release of your consumer report to {Insert Company Name}. Based on your authorization, {Insert Company Name} requested and received your consumer report. {Insert Company Name} is currently reviewing your consumer report to determine whether you qualify for employment/promotion with {Insert Company Name} based on its employment/promotion criteria.{Insert Company Name} may decide not to hire/promote you based in whole or in part on your consumer report. Because {Insert Company Name} may make a decision about hiring/promoting you based in whole or in part on your consumer report, {Insert Company Name}is providing you with this pre-adverse action notice as required by the Fair Credit Reporting Act, as amended (“FCRA”). Enclosed with this letter are two documents for your review and information: (1) A copy of your consumer report that was requested and reviewed by (Company name); and, (2) A Summary of Your Rights Under the FCRA.The consumer report that {Insert Company Name} requested and received about you was not prepared by {Insert Company Name}. If you have any questions or concerns regarding your consumer report, please contact {Insert Reporting Agency Name, Address, and Telephone Number} or the agencies listed in the Summary of Your Rights Under the FCRA. If you have any employment/promotion related questions or concerns, please do not hesitate to contact us.We sincerely thank you for your interest in working/seeking promotion for {Insert Company Name}. {Insert Company Name} will contact you as soon as a decision is made regarding your interest in employment with/promotion within {Insert Company Name}.Sincerely,__________________________________(Signature) Enclosures:Summary of Consumer RightsCopy of Consumer Report