[Sender’s name]
[Street Address]
								[Sender’s City, State, Zip]

[Employer’s Name]
[Company Name]
[Street Address]
[City, State  Zip Code]

To Whom It May Concern:

[insert name of company/firm/agency] denied me a job on [date] for the position of [title of position], and I am requesting that within 30 days you provide me with a written statement stating the reasons for such denial.  I am entitled to this statement under Article 23A of the New York State Correction Law because I have (a/some) criminal conviction(s).  Section 754 of the Correction Law states:  

At the request of any person convicted of one or more criminal offenses who has been denied a license or employment, a public agency or private employer shall provide, within thirty days of a request, a written statement setting forth the reasons for such denial.  Failure to provide a written statement may result in a complaint being filed with the NYS Division of Human Rights.

If you used a consumer reporting agency background report to make your employment determination, the federal Fair Credit Reporting Act requires an employer to give a prospective employee a copy of the report and a reasonable amount of time to review the report before it denies employment. 15.U.S.C. § 1681b(b)(3).   Therefore, if you used a consumer agency background report when considering me for the job, please enclose a copy with the letter requested above.     

Thank you for your prompt attention to this matter.

Sincerely,

[Your Name]