Fill and Sign the Employer Certification of Compliance Form

Certification of Compliance Basic form © James R. McDade, Esq. (ver 07-22-05) 209-667-2300 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: [Consumer Reporting Agency]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 [Insert Date] 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: _________________________________ _________________________Employer Representative Title