Adverse Action Form PDF Details

The adverse action form is one of the most important forms in business. It protects employers and employees alike from liability for wrongful termination, discrimination, harassment and retaliation claims. The adverse action form can be completed by either the employer or the employee depending on who initiated the separation process. If you are an employer who would like to terminate an employee's employment with your company, then it is imperative that you use this form as a legal document that will protect both parties involved in any potential litigation proceedings. This blog post provides some information about what to include when filling out this type of form so there are no discrepancies between different versions of this document which could lead to confusion down the line.

Below is some data that could be beneficial if you are seeking to find out just how long it will require you to fill out adverse action form and how many PDF pages it contains.

QuestionAnswer
Form NameAdverse Action Form
Form Length7 pages
Fillable?Yes
Fillable fields29
Avg. time to fill out7 min 37 sec
Other names3P, QualiFile, Chex, consumerdebit

Form Preview Example

Chex Systems, Inc.

Notice of Adverse Action Form Samples

Release Date: January 2012

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Chex Systems, Inc. Notice of Adverse Action Form Samples (Release Date: January 2012)

 

Copyright © 2012 Fidelity National Information Services and/or its subsidiaries. All Rights Reserved.

 

INFORMATION ABOUT THIS DOCUMENT

 

As a o e ie e, Che “ ste s, I . ChexSystems

a pro ide or other ise ake a aila le to its

customers certain sample adverse action forms, procedures, or other similar information (collectively, Materials . ChexSystems customers acknowledge and agree that the Materials were created for general

application and have not been customized to address usto ers’ specific business operations. ChexSystems does not guarantee that the Materials will comply with any applicable laws, rules or regulations, and the customer is responsible for its use of Materials and bears sole liability for any such use.

Samples in this document include:

1.ChexSystems Adverse Action Notice, without Credit Score Disclosure

2.ChexSystems Adverse Action Notice, with Credit Score Disclosure

3.ChexSystems, plus Credit Bureaus Adverse Action Notice, with Credit Score Disclosure

CHEXSYSTEMS POSITION ON THE CREDIT SCORE DISCLOSURE REQUIREMENT

ChexSystems is not taking a position on whether or not its customers are required to provide the Credit Score Disclosure to declined account applicants; rather, each financial institution is responsible for making this determination on its own behalf. As a convenience to its customers that elect to provide the Credit Score Disclosure to declined account applicants, ChexSystems is now making available the data fields necessary to support the Credit Score Disclosure requirements set forth by the Dodd-Frank Act. These additional data fields are provided in the ChexSystems QualiFile electronic inquiry response.

Chex Systems, Inc. (herein ChexSystems) is a consumer reporting agency and

an indirect wholly owned subsidiary of Fidelity National Information Services, Inc.

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Chex Systems, Inc. Notice of Adverse Action Form Samples (Release Date: January 2012)

 

Copyright © 2012 Fidelity National Information Services and/or its subsidiaries. All Rights Reserved.

 

Notice of Adverse Action

Notice Date:

We are sorry but we are unable to accommodate your request to open a deposit account with our institution at this time. Our decision was based in whole or in part on information obtained in a report from the consumer reporting agency listed below. You have a right under the Fair Credit Reporting Act to know the information contained in your file at the consumer reporting agency. The reporting agency played no part in our decision and is unable to supply specific reasons why we have denied your request to open a deposit account in our institution. You also have a right to a free copy of your report from the reporting agency, if you request it no later than 60 days after you receive this notice. In addition, if you find that any information contained in the report you receive is inaccurate or incomplete, you have the right to dispute the matter with the reporting agency.

Chex Systems, Inc.

Attn: Consumer Relations

7805 Hudson Road, Suite 100

Woodbury, MN 55125

Telephone: 800-428-9623

Fax: 602-659-2197

Web: www.consumerdebit.com

If you have any questions regarding your consumer report, you should contact the consumer reporting agency using the contact information above.

If you have any other questions regarding this notice, you should contact:

Institution name:

Institution address:

Institution toll-free telephone number:

As a convenience, Chex may provide or otherwise make available to Client certain sample adverse action forms, procedures, or other similar information (collectively,

Materials ). Clie t a k o ledges a d agrees that the Materials ere reated for ge eral appli atio a d ha e ot ee usto ized to address Clie t’s spe ifi business operations. Chex does not guarantee that the Materials will comply with any applicable laws, rules or regulations, and Client is responsible for its use of Materials and bears sole liability for any such use.

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Chex Systems, Inc. Notice of Adverse Action Form Samples (Release Date: January 2012)

 

Copyright © 2012 Fidelity National Information Services and/or its subsidiaries. All Rights Reserved.

 

Notice of Adverse Action

Notice Date:

We are sorry but we are unable to accommodate your request to open a deposit account with our institution at this time. Our decision was based in whole or in part on information obtained in a report from the consumer reporting agency listed below. You have a right under the Fair Credit Reporting Act to know the information contained in your file at the consumer reporting agency. The reporting agency played no part in our decision and is unable to supply specific reasons why we have denied your request to open a deposit account in our institution. You also have a right to a free copy of your report from the reporting agency, if you request it no later than 60 days after you receive this notice. In addition, if you find that any information contained in the report you receive is inaccurate or incomplete, you have the right to dispute the matter with the reporting agency.

Chex Systems, Inc.

Attn: Consumer Relations

7805 Hudson Road, Suite 100

Woodbury, MN 55125

Telephone: 800-428-9623

Fax: 602-659-2197

Web: www.consumerdebit.com

We also obtained your credit score from this consumer reporting agency and used it in making our credit decision. Your credit score is a number that reflects the information in your consumer report. Your credit score can change, depending on how the information in your consumer report changes.

Credit Score:

 

Score Date:

Scores range from a low of 100 to a high of 9999

Key factors that adversely affected your credit score (insert here the four key factors that adversely affected the credit score or if the number of recent inquiries is a key factor, insert five key factors including the number of recent inquiries):

If you have any questions regarding your credit score, you should contact the consumer reporting agency using the contact information above.

If you have any other questions regarding this notice, you should contact:

Institution name:

Institution address:

Institution toll-free telephone number:

As a convenience, Chex may provide or otherwise make available to Client certain sample adverse action forms, procedures, or other similar information (collectively,

Materials ). Clie t a k o ledges a d agrees that the Materials ere reated for ge eral appli atio a d ha e ot ee usto ized to address Clie t’s spe ifi

business operations. Chex does not guarantee that the Materials will comply with any applicable laws, rules or regulations, and Client is responsible for its use of Materials and bears sole liability for any such use.

CONFIDENTIAL

5 | P a g e

Chex Systems, Inc. Notice of Adverse Action Form Samples (Release Date: January 2012)

 

Copyright © 2012 Fidelity National Information Services and/or its subsidiaries. All Rights Reserved.

 

Notice of Adverse Action

Notice Date:

We are sorry but we are unable to accommodate your request to open a deposit account with our institution at this time. Our decision was based in whole or in part on information obtained in a report from one or more of the consumer reporting agencies listed below. You have a right under the Fair Credit Reporting Act to know the information contained in your file at the consumer reporting agency. The reporting agency played no part in our decision and is unable to supply specific reasons why we have denied your request to open a deposit account in our institution. You also have a right to a free copy of your report from the reporting agency, if you request it no later than 60 days after you receive this notice. In addition, if you find that any information contained in the report you receive is inaccurate or incomplete, you have the right to dispute the matter with the reporting agency.

 

 

ChexSystems

 

 

Experian

 

 

Equifax

 

 

Trans Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chex Systems, Inc.

Experian

Equifax Credit Information Services

TransUnion Consumer Relations

Attn: Consumer Relations

PO Box 2002

PO Box 740241

PO Box 1000

7805 Hudson Road, Suite 100

Allen, TX 75013

Atlanta, GA 30374

Chester, PA 19022

Woodbury, MN 55125

 

 

 

 

 

 

 

 

 

 

 

 

Telephone: 888-397-3742

Telephone: 800-685-1111

Telephone: 800-888-4213

Telephone: 800-428-9623

Web:

 

 

 

Web:

Fax: 602-659-2197

www.experian.com/reportaccess

 

 

 

www.transunion.com/myoptions

Web: www.consumerdebit.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To contact ChexSystems in

If you prefer to use a mailed

To contact Equifax in writing,

If you prefer to mail a request,

writing, forward your request

request, send the following

forward your request including

please provide your first name,

including your full name,

information to Experian: your full

your name, address, former

last name, middle initial, current

including middle initial, current

name, including middle initial and

address (if you have been at your

address, Social Security number,

address, US Social Security

generation such as SR, JR, II, etc.;

current address less than two

date of birth, any previous

number, date of birth and any

current mailing address; Social

years), Social Security Number

addresses used in the past five

previous addresses used in the

Security number; date of birth;

(required) and the name of the

years (include any PO Boxes).

last five years (including PO

previous addresses for the past

company that referred you to

 

 

 

Boxes).

two years; and two proofs of your

Equifax.

 

 

 

 

 

 

current mailing address, such as

 

 

 

 

 

 

 

 

 

dri er’s li e se, utilit ill, a k or

 

 

 

 

 

 

 

 

 

insurance statement, etc.

 

 

 

 

 

 

As a convenience,

Chex may provide or otherwise make available to Client certain sample adverse action forms, procedures, or other similar information (collectively,

Materials ). Clie

t a k o ledges a d agrees that the Materials ere reated for ge eral appli atio a d ha e ot ee usto ized to address Clie t’s spe ifi

business operations. Chex does not guarantee that the Materials will comply with any applicable laws, rules or regulations, and Client is responsible for its use of Materials and bears sole liability for any such use.

Sample Form Continues on Next Page….

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Chex Systems, Inc. Notice of Adverse Action Form Samples (Release Date: January 2012)

 

Copyright © 2012 Fidelity National Information Services and/or its subsidiaries. All Rights Reserved.

 

We also obtained your credit score from this consumer reporting agency and used it in making our credit decision. Your credit score is a number that reflects the information in your consumer report. Your credit score can change, depending on how the information in your consumer report changes.

Credit Score:

 

Score Date:

Scores range from a low of 100 to a high of 9999

Key factors that adversely affected your credit score (insert here the four key factors that adversely affected the credit score or if the number of recent inquiries is a key factor, insert five key factors including the number of recent inquiries):

If you have any questions regarding your credit score, you should contact the consumer reporting agency using the contact information above.

If you have any other questions regarding this notice, you should contact:

Institution name:

Institution address:

Institution toll-free telephone number:

As a convenience, Chex may provide or otherwise make available to Client certain sample adverse action forms, procedures, or other similar information (collectively,

Materials ). Clie t a k o ledges a d agrees that the Materials ere reated for ge eral appli atio a d ha e ot ee usto ized to address Clie t’s spe ifi business operations. Chex does not guarantee that the Materials will comply with any applicable laws, rules or regulations, and Client is responsible for its use of Materials and bears sole liability for any such use.

Contact Us

For more information about Risk, Fraud, and Compliance Solutions

 

e-mail us at:

MoreInfo@fisglobal.com

 

or visit us on the Web:

www.fisglobal.com/products-riskfraudcompliance

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Chex Systems, Inc. Notice of Adverse Action Form Samples (Release Date: January 2012)

 

Copyright © 2012 Fidelity National Information Services and/or its subsidiaries. All Rights Reserved.

 

How to Edit Adverse Action Form Online for Free

We were making the PDF editor with the prospect of making it as effortless to work with as it can be. This is why the procedure of creating the 3P will be easy perform these particular actions:

Step 1: Press the "Get Form Now" button to begin.

Step 2: You're now on the file editing page. You may edit, add information, highlight specific words or phrases, place crosses or checks, and insert images.

Type in the details requested by the software to get the form.

consumerdebit spaces to fill in

Write the demanded information in the If you have any questions area.

Filling in consumerdebit stage 2

It is essential to write some information in the field Notice Date: We are sorry but we, Chex Systems, Attn: Consumer Relations, 7805 Hudson Road, Woodbury, Telephone: 800-428-9623, Fax: 602-659-2197, Web: www, Score Date:, and We also obtained your credit score.

Finishing consumerdebit stage 3

The We also obtained your credit score, and CONFIDENTIAL 5 | P a g e Chex field will be used to put down the rights or obligations of each party.

Filling out consumerdebit part 4

Fill in the template by analyzing all of these areas: Notice Date: We are sorry but we, ChexSystems Chex Systems, Experian, Equifax, Trans Union, Experian PO Box 2002 Allen, Equifax Credit Information, and TransUnion Consumer Relations PO.

Completing consumerdebit stage 5

Step 3: Hit "Done". It's now possible to export the PDF document.

Step 4: Make duplicates of your document - it will help you stay clear of upcoming worries. And don't be concerned - we are not meant to publish or check your information.

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