This form can be used to conduct a criminal background check after (1) a conditional offer of employment has been made to a job applicant and (2) the Notice of Preliminary Decision to Withdraw Employment Offer and the procedures described in it have been provided. Criminal background inquiries cannot be conducted prior to a conditional job offer and a final decision to withdraw an offer of employment based in any part on criminal history cannot be made until the Preliminary Notice and procedures have been provided.
Use this form to notify an applicant that you have made the final decision to withdraw his/her conditional job offer based, at least in part, on a criminal background check.
For information on obtaining and using criminal history, see Restrictions on Obtaining Criminal History and Obtaining Background Checks and Investigations by Employers. For information on investigative consumer reports, see Obtaining Investigative Consumer Reports.
This form is not intended for use if you are hiring in San Francisco or the City of Los Angeles; these cities are covered by the San Francisco Fair Chance Ordinance or the Los Angeles Fair Chance Initiative in Hiring Ordinance.
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