Employer Certification of Compliance

EMPLOYER CERTIFICATION OF COMPLIANCE
FOR CONSUMER REPORTS

Note: Employers deliver this document to the Consumer Reporting Agency after the
“Disclosure And Authorization Regarding Request For Consumer Report” is received from the
prospective or current employee. (Delete this note prior to use.)

Date:

To:

From: Employer:

Re: Prospective or Current Employee ("Consumer"):

On behalf of the above-identified Employer, the undersigned representative certifies as follows:

1. The above-referenced Consumer was notified on that the Employer requested
a consumer report regarding the Consumer for employment purposes. A copy of the notice
provided to the Consumer that, if applicable, describes the nature and scope of the
requested investigative report is attached.

2. The Consumer was provided with a copy of the publication entitled “A Summary of Your
Rights under the Fair Credit Reporting Act" outlining the Consumer's rights under the Fair
Credit Reporting Act.

3. Information from the consumer report will not be used in violation of any applicable Federal
or State laws or regulations.

4. Prior to the Employer taking any adverse action based in whole or in part upon the
consumer report, the Consumer shall be provided a copy of the report together with a
written description of the rights of the Consumer under the Fair Credit and Reporting Act, as
prescribed by applicable regulation of the Federal Trade Commission.

5. The purpose of the report is related to employment of the Consumer, for the exclusive use
of the Employer in evaluating compliance with employment policies, and/or the Consumer's
eligibility for employment, promotion, reassignment or retention as an employee, or the need
for appropriate disciplinary or remedial action.

6. The Consumer has given written authorization for the procurement and use of the consumer
report by the Employer.

By:

Certification of Compliance
Basic form © James R. McDade, Esq. (ver 07-22-05) 209-667-2300