Certification of Compliance with Fair Credit Reporting Act

CERTIFICATION

Company Name:

Address:

City, State, and Zip Code:

In compliance with the Fair Credit Reporting Act (”FCRA”), as amended by the Consumer Credit Reporting Act of 1996, as amended by the Consumer Reporting Employment Clarification Act of 1998, {Insert Company Name} hereby certifies to {Insert Name of Reporting Agency} that it has complied or will comply with the following provisions:

We have:

1. Made a written, clear and conspicuous disclosure to the applicant or current employee, in a document consisting solely of that document, that a consumer report may be obtained for employment purposes;

2. Obtained written authorization from the applicant or current employee before ordering any consumer reports regarding that individual.

We will:

1. Advise the applicant, or current employee, if applicable, that before any adverse action is taken with regard to that individual, which is based in whole or in part on a consumer report that, we will provide to the individual a copy of the consumer report and a description in writing of the rights the individual has with regard to the report as prescribed by the Federal Trade Commission. (“Summary of Your Rights”);

2. Not use the information provided in the consumer report to violate any applicable federal or state equal employment opportunity law or regulation.

The undersigned agrees to abide by all of the above referenced provisions as provided by the FCRA, as amended.

Date: