California Employment Adverse Action Notice

California Employment Adverse Action Notice

Before use: Send this only after the applicable pre-adverse notice, report, and CFPB rights summary were delivered and a final decision was made. For a conviction-history decision covered by Cal. Gov. Code § 12952, allow at least five business days after the applicant receives the preliminary notice to respond. Allow five additional business days if, during the initial period, the applicant notifies the employer in writing that the conviction-history report is inaccurate and that the applicant is taking specific steps to obtain supporting evidence. Consider information submitted during the applicable period before making the final decision. 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]

California Report Disclosures (complete the applicable paragraph; delete unused paragraphs)

Consumer credit report used: This decision was based in whole or in part on information in a consumer credit report. You may obtain a free copy of your consumer credit report from the agency identified above if you request it within 60 days after receiving this notice and from any other consumer credit reporting agency that compiles and maintains files on consumers nationwide. You may dispute the accuracy or completeness of information in the report with the reporting agency.

Investigative consumer report used: An investigative consumer report was obtained in connection with this decision. The investigative consumer reporting agency that made that report is [AGENCY NAME], at [AGENCY MAILING ADDRESS].

Conviction-History Final Decision (include if applicable; otherwise delete)

If this is a final denial based solely or partly on conviction history for a position covered by California Government Code section 12952, include this section only after the required preliminary notice, response period, and consideration of information the applicant submitted. We have made a final decision to deny your application or withdraw the conditional offer for the position above.

Preliminary notice received by applicant: [DATE]. Initial five-business-day response period ended: [DATE]. Applicant gave written notice of an accuracy dispute and steps to obtain evidence within that period: [YES / NO]. If yes, additional five-business-day period ended: [DATE]. Information received and considered before final decision: [DATE / NONE].

Our existing procedure to challenge this decision or request reconsideration is: [PROCEDURE AND CONTACT / NO EXISTING PROCEDURE]. You have the right to file a complaint with the California Civil Rights Department. Its official complaint process page explains how to do so.

Sincerely,

[EMPLOYER REPRESENTATIVE NAME]
[TITLE]
[EMPLOYER CONTACT INFORMATION]

Sources and References

• 15 U.S.C. § 1681m(a)
• 15 U.S.C. § 1681g(f)(1)(B)–(E)
• Cal. Civ. Code § 1785.20(a)(4)
• Cal. Civ. Code § 1786.40(a)
• Cal. Gov. Code § 12952(c)(5)
• California Civil Rights Department, Fair Chance Act sample notices (August 2025)