Sample forms — free, editable, ready to brand.
The core FCRA disclosure, authorization, and adverse-action templates your team needs to run a compliant program — plus the state-specific notices that layer on top. Modeled on the public forms published by the Federal Trade Commission and the Consumer Financial Protection Bureau.
Before you deploy any of these forms: Review with your employment counsel and confirm they match the statutes in every jurisdiction where you hire. These templates are provided for informational purposes only and do not constitute legal advice. Replace the {Employer Name} placeholder with your company name before use.
Federal FCRA forms
Core disclosure, authorization, and adverse-action templates required by the Fair Credit Reporting Act, 15 U.S.C. §1681 et seq.
Disclosure and Authorization to Obtain a Consumer Report
Standalone disclosure with candidate authorization, drafted to satisfy §1681b(b)(2)(A). Provide as a separate document — not embedded in an employment application.
15 U.S.C. §1681b(b)(2)
A Summary of Your Rights Under the FCRA
The CFPB model summary that must accompany every consumer report used for employment purposes and every pre-adverse and final adverse-action notice.
12 C.F.R. Part 1022, Appendix K
Pre-Adverse Action Notice
Model letter sent to the candidate with a copy of the report and the Summary of Rights, giving the candidate a reasonable window (SafestHires recommends 5 business days) to dispute before the employer finalizes any decision.
15 U.S.C. §1681b(b)(3)
Final Adverse Action Notice
Sent after the reasonable waiting period if the employer proceeds with the adverse decision. Names the consumer reporting agency and preserves the candidate's right to a free file copy within 60 days.
15 U.S.C. §1681m(a)
Additional Disclosure — Investigative Consumer Report
Required when the report includes personal interviews with references, neighbors, or associates. Provides the candidate the right to request the nature and scope of the investigation.
15 U.S.C. §1681d
Federal Consumer Report Disclosure
SafestHires-branded standalone federal disclosure naming SafestHires, Inc. as the consumer reporting agency and describing the categories of information that may appear in the report. Provide with A Summary of Your Rights Under the FCRA and before the applicant signs any authorization.
15 U.S.C. §1681b(b)(2)(A)
State disclosures & fair chance notices
Layer these on top of the federal forms whenever you screen candidates in the listed states or cities.
State law disclosures — CA, ME, MN, MA, NJ, NY, WA
A single supplement covering the additional consumer-report disclosures required by California (ICRAA), Maine, Minnesota, Massachusetts, New Jersey, New York, and Washington. Provide alongside the federal FCRA disclosure.
Cal. Civ. Code §1786.22 · 10 M.R.S. §1320 · Minn. Stat. §13C.02 · Mass. Gen. Laws ch. 93 §62 · N.J.S.A. 56:11-31 · N.Y. Gen. Bus. Law §380-c · RCW 19.182.070
California investigative consumer report disclosure
Standalone California disclosure with the Cal. Civ. Code §1786.22 summary of rights and the free-copy checkbox candidates use to request a copy of their report.
Cal. Civ. Code §1786 et seq. (ICRAA)
Los Angeles Fair Chance Initiative for Hiring notice
Applicant notice explaining ban-the-box, the required Individualized Assessment, and the five-day Fair Chance Process for reconsideration.
L.A.M.C. §189.00
San Francisco Fair Chance Ordinance notice
Applicant notice and workplace posting covering ban-the-box, the seven-year lookback carve-outs, and the seven-day candidate reconsideration window.
S.F. Police Code Art. 49
New York Article 23-A Notice
Standalone notice of the eight-factor analysis a New York employer must perform before disqualifying a candidate based on a criminal conviction, with the statutory right to request a copy of Article 23-A.
N.Y. Corr. Law Art. 23-A · N.Y. Gen. Bus. Law §380-c(b)
Washington Fair Chance Act Notice
Notice to Washington applicants explaining that criminal history will not be considered until after an initial qualification determination, and describing the enforcement path through the Washington Attorney General.
RCW 49.94
Driver & DOT forms
Consents and disclosures for roles that require motor vehicle records, commercial driver history, or FMCSA Pre-Employment Screening reports.
Georgia motor vehicle report consent
Driver's consent — under O.C.G.A. §40-5-2 — to release a Georgia MVR to the employer and to SafestHires. Supports Georgia DDS Form DDS-18.
O.C.G.A. §40-5-2
Pennsylvania driver record consent
Consent for release of a Pennsylvania driver record through PennDOT Form DL-503 for employment purposes, including the 10-year record option.
75 Pa.C.S. §6114 · PennDOT Form DL-503
Washington driving record release of interest
Two-part form: employer certification under penalty of perjury and applicant authorization for the Washington DOL driving record for employment purposes.
RCW 46.52 · DSC-425-009
CDLIS commercial driver consent
Instrument of Written Consent required before CDLIS master pointer record data may be requested on a commercial driver — DPPA and FCRA compliant, retained for three years.
49 U.S.C. §31309 · DPPA · FCRA
FMCSA PSP disclosure and authorization
FMCSA-mandated Pre-Employment Screening Program disclosure and applicant authorization required before pulling a PSP report on a commercial driver.
49 U.S.C. §31150 · FMCSA PSP
DOT previous-employer release and safety-performance history
Two-part form: applicant release authorizing prior DOT-regulated employers to share drug and alcohol testing history and safety-performance data, plus the previous-employer response covering identification, accident register, and Part 40 testing history for the past three years.
49 CFR §40.25 · 49 CFR §391.23
Guam authorization for release of driving record
Applicant authorization for SafestHires to obtain a Guam driver abstract for employment purposes, aligned with 21 GCA §29125 and the federal Driver's Privacy Protection Act.
21 GCA §29125 · 18 U.S.C. §2721 (DPPA)
Puerto Rico authorization for release of driving record
Applicant authorization and adverse-action rights notice for a Puerto Rico driving record used for a legitimate business purpose, with the required FCRA candidate-rights language.
9 L.P.R.A. §5001 et seq. · 18 U.S.C. §2721 (DPPA)
U.S. Virgin Islands driver record release and authorization
Applicant authorization for SafestHires to obtain a USVI driver abstract for employment purposes, with the employer purpose-of-use certification the territory requires.
V.I. Code Ann. tit. 20 · 18 U.S.C. §2721 (DPPA)
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