Applicant/Employee Name: ______________________

Adverse Action Taken:  ______Not Hire  ______Terminate

Disclosure of Use of Information Obtained from an Outside Source

Our Adverse Action decision was based in whole or in part upon information received from the Consumer Reporting Agency listed below. You have the right under the federal Fair Credit Reporting Act (FCRA) to obtain a complete copy of the information we received. There is no cost to you for a copy of this report provided you request a copy within sixty (60) days of the date of this action. Also, the FCRA allows you to dispute the accuracy and/or completeness of the information contained in your consumer report. A copy of your consumer report may be obtained from:

HR First Contact

PO Box 490

Blue Bell, PA 19422

267-419-1390

NOTE:All requests must be in writing and may only be initiated by the individual who is the subject of the consumer report. Also, HR First Contact did not make the decision to take this adverse action and will not be able to provide you with specific reasons why this adverse action was taken.