Enter your company and your screening firm, and get a background check consent form the FCRA way: a disclosure on a page of its own, a separate authorization for the applicant to sign, and the investigative report notice when references may be interviewed. Copy it or print it. Nothing else is added to the disclosure.
Hand the applicant
2 separate pages
15 U.S.C. § 1681b(b)(2)(A)
Every required field is filled.
Page 1 of 2
Cedar & Pine Dental Group, LLC may obtain a consumer report about you from a consumer reporting agency for employment purposes.
The consumer reporting agency is Example Screening Services, Inc., 100 Main Street, Suite 200, Springfield, IL 62701, (555) 010-0199, www.screening.example.
Page 2 of 2
I have received the separate document titled “Disclosure: background report for employment purposes.”
I authorize Cedar & Pine Dental Group, LLC to obtain a consumer report about me from Example Screening Services, Inc. for employment purposes.
If I am hired, this authorization remains in effect for the whole period of my employment with Cedar & Pine Dental Group, LLC, and Cedar & Pine Dental Group, LLC may obtain further consumer reports about me for employment purposes during that time.
The builder turns five details into the paperwork the Fair Credit Reporting Act asks for before you order a background report on an applicant or employee: a disclosure that a consumer report may be obtained for employment purposes, and the person's written authorization. It puts each on its own page. If the consumer reporting agency may interview references or other people about the applicant, it adds a third page, the investigative consumer report notice.
Give the pages before you order the report, then keep the signed authorization in the hire's file. The full sequence that follows, from the certification you give the screening firm to the adverse action notices, is in the FCRA rules for employers.
The rule is one clause of 15 U.S.C. § 1681b(b)(2)(A)(i). The disclosure must be made
“in a document that consists solely of the disclosure, that a consumer report may be obtained for employment purposes”
The same paragraph lets the authorization sit on that document (clause (ii)), and an FTC staff letter from 1998 agreed the two “may be combined.” This builder still prints them on separate pages, so the disclosure page carries the disclosure and nothing else. The FTC's employer guidance adds that the notice must be “in a stand-alone format,” that it “cannot be in an employment application,” and that minor additional information is allowed only if it does not “confuse or detract from the notice.”
That is why the generator never adds the extras that template forms often carry:
A willful FCRA violation can cost $100 to $1,000 per affected person in statutory damages, plus punitive damages and the other side's attorney's fees. A negligent violation costs actual damages plus costs and fees.
15 U.S.C. §§ 1681n(a), 1681o(a)
Already have a form? Run it through the FCRA disclosure checker to find the extra wording before an applicant signs it.
What to do
A dental practice orders a criminal and employment-history check through a screening firm for a new hygienist. Four settings, and what the builder hands back for each:
| Setting | Pages | What changes |
|---|---|---|
| The example as loaded (whole-employment permission on, no interviews) | 2 | Disclosure, then authorization with the whole-employment sentence |
| Interview box ticked, request address filled | 3 | Adds the § 1681d notice and the Summary of Rights enclosure line |
| Whole-employment permission off | 2 | The authorization drops its last sentence |
| Employer name left empty | 2 | [Employer's legal name] appears in place; the field says what is missing |
The disclosure in the loaded example reads, in full: “Cedar & Pine Dental Group, LLC may obtain a consumer report about you from a consumer reporting agency for employment purposes. The consumer reporting agency is Example Screening Services, Inc., 100 Main Street, Suite 200, Springfield, IL 62701, (555) 010-0199, www.screening.example.” Two sentences is the point.
A report becomes an investigative consumer report when information on a person's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with neighbors, friends, associates or others who know them (15 U.S.C. § 1681a(e)). Reference interviews run by a screening firm can fall inside that. The notice must tell the person such a report may be made, state their right to ask for the nature and scope of the investigation, and come with the written summary of rights.
Mail or deliver the notice in writing no later than three days after the report was first requested. If the person asks in writing, disclose the nature and scope of the investigation within five days of the request or of the first request for the report, whichever is later.
15 U.S.C. § 1681d(a)(1)(A), (b)
FTC staff have said a very limited notice of intent to get an investigative report may go with the disclosure, but the nature-and-scope description may not. The builder keeps the whole notice on its own page, with the CFPB's A Summary of Your Rights Under the Fair Credit Reporting Act enclosed (the March 2023 version, required since March 20, 2024). More on that form in when to send the Summary of Rights.
The pages above follow federal law only. State and city law may require separate notices of their own, and the builder does not draft them. Keep them off the federal disclosure page: the statute says that page “consists solely of the disclosure,” and where a local notice goes is a question for your counsel.
Some state and city rules also add steps after the report comes back. See the California Fair Chance Act, the NYC Fair Chance Act, ban the box laws by state and credit checks for employment. When a report leads you toward a no, the adverse action timeline sets the dates.