Employment Adverse Action Notice
Employment Adverse Action Notice
Before use: Send this only after the pre-adverse notice, the report and the CFPB rights summary were delivered, the response opportunity was allowed, and a final decision was made. Complete the score section only if a numerical credit score was used in the decision; otherwise delete that section.
Date: [__/__/____]
Delivery method: [________________________________]
To: [APPLICANT NAME]
Address or email: [________________________________]
From: [EMPLOYER NAME]
Position: [________________________________]
Final Decision
We have decided [NOT TO HIRE YOU / TO WITHDRAW OUR CONDITIONAL OFFER / OTHER SPECIFIC ADVERSE EMPLOYMENT DECISION] for the position above. Information in a consumer report supplied by the agency below was a factor in this decision.
The consumer reporting agency did not make this decision and cannot give you the specific reasons for our decision. The agency's contact details are:
- Name: [AGENCY NAME]
- Mailing address: [AGENCY ADDRESS]
- Telephone: [AGENCY PHONE]
- Nationwide agency toll-free number, if applicable: [TOLL-FREE NUMBER]
You have the right to obtain a free copy of your report from this agency if you request it within 60 days after receiving this notice. You also have the right to dispute with the agency the accuracy or completeness of information in the report.
Credit score used in this decision (delete if no numerical credit score was used)
- Numerical credit score used: [SCORE]
- Range of possible scores under the model used: [LOW] to [HIGH]
- Key factors that adversely affected the score, in order of importance (up to four; include inquiries as an additional factor when applicable): [FACTORS]
- Date the score was created: [__/__/____]
- Person or entity that provided the score or credit file used to create it: [NAME]
Sincerely,
[EMPLOYER REPRESENTATIVE NAME]
[TITLE]
[EMPLOYER CONTACT INFORMATION]
Sources and References
About this template
- Last updated
- October 14, 2026
- Citations checked
- October 14, 2026
- Jurisdiction
- All states
- Category
- Employment & HR
Legal authority
- 15 U.S.C. § 1681m(a)
- 15 U.S.C. § 1681g(f)(1)(B)–(E)
- 15 U.S.C. § 1681g(f)(9)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 14, 2026.
15 U.S.C. § 1681m(a) (checked October 14, 2026): "If any person takes any adverse action with respect to any consumer that is based in whole or in part on any information contained in a consumer report, the person shall— (1) provide oral, written, or electronic notice of the adverse action to the consumer"
15 U.S.C. § 1681m(a)(3) (checked October 14, 2026): "the name, address, and telephone number of the consumer reporting agency (including a toll-free telephone number established by the agency if the agency compiles and maintains files on consumers on a nationwide basis) that furnished the report to the person; and (B) a statement that the consumer reporting agency did not make the decision to take the adverse action"
15 U.S.C. § 1681m(a)(2) (checked October 14, 2026): "provide to the consumer written or electronic disclosure— (A) of a numerical credit score as defined in section 1681g(f)(2)(A) of this title used by such person in taking any adverse action"
15 U.S.C. § 1681g(f)(1)(B)–(E) (checked October 14, 2026): "the range of possible credit scores under the model used; (C) all of the key factors that adversely affected the credit score of the consumer in the model used, the total number of which shall not exceed 4, subject to paragraph (9); (D) the date on which the credit score was created; and (E) the name of the person or entity that provided the credit score or credit file upon which the credit score was created."
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