How to Fill Out and Deliver the NYC Fair Chance Act Notice Form

The NYC Fair Chance Act Notice form is a two-page PDF, published by the NYC Commission on Human Rights, that an employer must complete and deliver to an applicant or current employee before withdrawing a conditional job offer or taking other adverse action based on a criminal record.¹ The form walks you through a nine-factor analysis drawn from Article 23-A of the New York Correction Law, tying each conviction to the specific duties of the job. Rushing it or skipping steps can expose the employer to civil penalties of up to $250,000.²

What to Have in Front of You Before You Start

Pull three things together before opening the PDF.

The background check report is first. Every conviction you list, every date you cite, and every risk you describe has to trace back to that report. If the report has errors, work from what you actually have, not from assumptions.

Second, a written description of the job’s duties. The form asks you to explain why a specific conviction matters for this specific role, and vague job summaries make that section nearly impossible to complete defensibly.

Third, anything the applicant has already given you that speaks to rehabilitation or fitness: resume, certifications, references, training records. The form requires you to acknowledge this evidence, so it needs to be in front of you when you write.

One separate caution while you’re assembling records: NYC’s Stop Credit Discrimination in Employment Act bars using consumer credit history in hiring decisions. Some screening packages bundle credit information into a criminal background report. Do not let credit information leak into your Fair Chance analysis.³

Records You Must Ignore

Some criminal history items are off-limits even when they appear on the report. If any of the following show up, exclude them from your notice entirely:

Arrests that did not lead to conviction, cases resolved with a not-guilty finding, and sealed cases.
Cases adjourned in contemplation of dismissal that have not been revoked and restored for prosecution.
Violations such as disorderly conduct, which are not criminal convictions under New York law.
Youthful offender and juvenile delinquency adjudications.⁴

An applicant asked about any of these categories is entitled to answer “no.” Treat the report as if those entries were not there.

Completing the Header Fields

The form opens with a paragraph addressed to the applicant stating that the employer has reviewed their criminal record, has reservations about the hire, and may withdraw the offer. Three fields need to be filled in inside that opening:

The job title.
The number of days the applicant has to respond, which must be at least five business days.
Contact information for where the applicant should send their response.

Working Through Factors A Through I

The evaluation section is nine factors, each with a checkbox and a space for written explanation. Eight of them come from Section 753 of the Correction Law; the ninth (the certificate factor) is added by the city.⁵

Factor A asks you to acknowledge New York’s public policy encouraging the employment of people with criminal records. Check the box.

Factor B asks for the specific duties and responsibilities of the job. Be concrete. “Handles cash deposits” or “supervises children” is useful; “general office work” is not.

Factor C is the core of the analysis: how does the conviction affect the applicant’s ability to perform the duties you described in Factor B? Write a real explanation. A statement that the conviction is “concerning” will not survive review.

Factor D records how long ago the conduct occurred, counted from the date of the underlying conduct rather than the date of conviction. Enter years and months.

Factor E is the applicant’s age at the time of the conduct. Age 25 or younger is treated on the form as a mitigating factor.

Factor F is your assessment of the seriousness of the conduct itself.

Factor G lists evidence of rehabilitation or good conduct the applicant has provided: training, degrees, reference letters, volunteer work. This is where the materials you gathered earlier go.

Factor H is your legitimate business interest in protecting property or the safety of specific people or the public.

Factor I asks whether the applicant holds a Certificate of Relief from Disabilities or a Certificate of Good Conduct. If they do, you must presume they are rehabilitated. If they don’t, you cannot hold the absence of a certificate against them.⁴

Writing the Determination

After the nine factors, the form asks for your bottom-line conclusion. You must select one or both of two grounds:

Direct relationship: there is a direct link between the criminal record and the job, and the mitigating factors do not lessen that link enough.
Unreasonable risk: employing the applicant would create an unreasonable risk to specific people, the general public, or property.

Explain the choice in writing. Checking a box without a real explanation is treated the same as not doing the analysis at all. A defensible entry for a cash-handling position rejected on a recent embezzlement conviction would say plainly that the conviction involved theft of employer funds, the role requires unsupervised access to cash, and the time elapsed is short enough that it does not outweigh the risk. Boilerplate about “company policy” will not satisfy the requirement.⁶

Delivering the Packet

Send the applicant three items together:

The completed Fair Chance Act Notice with your written factor analysis.
A copy of the background check or other documents you relied on.
Information about how and when to respond.

Then hold the position open for at least five business days from delivery.⁴ Calendar days and weekends do not count. During that window, the applicant may dispute the accuracy of the record, submit additional evidence of rehabilitation, or provide letters of recommendation. If they respond, reconsider the analysis in good faith. Simply acknowledging the response and proceeding with the withdrawal is not enough.

If you still decide to withdraw the offer after the waiting period, send the applicant a final decision letter and keep copies of everything: the completed form, the background report, any correspondence, and the final decision. That documentation is the defense if the applicant later files a discrimination complaint.

Current Employees and Pending Charges

The same form and process apply when the person is already on payroll. If you learn about a current employee’s conviction or pending charge, you evaluate the record against the job duties, write up your findings, and give the employee an opportunity to respond before firing, demoting, or otherwise disciplining them.⁷

Pending charges shift the analysis. Skip Factor C, since it depends on there being a conviction, and focus on whether continuing employment poses an unreasonable risk to property or to the safety of people the employee interacts with. You may place the employee on a leave of absence for up to five business days while you complete the review, but the written determination explaining any adverse action is still required.⁶

When the Form Does Not Apply

A few situations sit outside the Fair Chance Act. Applicants for police and peace officer positions are not covered. Neither is any hire where a separate federal, state, or local law removes the employer’s discretion, such as the state prohibition on registered sex offenders working in childcare. If your discretion is intact, the fair-chance process applies; if the law forbids the hire outright, it does not.⁸

If a Screening Company Ran the Check

When the background report came from a third-party consumer reporting agency, the federal Fair Credit Reporting Act layers its own requirements on top of the city process. Before the report is ordered, the applicant needs a standalone written disclosure and must sign an authorization. When you decide to take adverse action, the FCRA requires its own pre-adverse-action notice: a copy of the consumer report plus the document titled “A Summary of Your Rights Under the Fair Credit Reporting Act.”⁹

Employers typically include the FCRA documents inside the same delivery as the Fair Chance packet. The five-business-day NYC waiting period generally exceeds the FCRA’s “reasonable time” standard, so meeting the city rule usually satisfies the federal timeline.

What Happens If You Get It Wrong

The NYC Commission on Human Rights enforces the Act. The violations it pursues most often are asking about criminal history before a conditional offer, failing to provide the written notice, skipping the factor analysis, and not holding the position open during the waiting period.

Civil penalties run up to $125,000 per violation, rising to $250,000 where the violation was willful, wanton, or malicious.² The Commission can also order the employer to hire the applicant, pay back wages, and change its hiring practices going forward. An applicant who believes the process was mishandled has one year to file with the Commission or three years to sue in New York State Supreme Court.¹⁰ Keeping the completed form, the report, and the correspondence in a single file is the practical answer to that exposure.

1
NYC.gov. Fair Chance Act Notice
2
NYC Council. NYC Administrative Code 8-126 – Civil Penalties Imposed by Commission for Unlawful Discriminatory Practices
3
NYC Commission on Human Rights. Stop Credit Discrimination in Employment Act: Legal Enforcement Guidance
4
NYC Commission on Human Rights. Fair Chance Act: Fact Sheet for Employers
5
New York State Division of Criminal Justice Services. New York Correction Law Article 23-A
6
NYC Council. NYC Administrative Code 8-107 – Unlawful Discriminatory Practices
7
NYC.gov. Fair Chance Act in Employment
8
Community Service Society of New York. Fair Chance Act FAQ: How Does the New Law Work?
9
Federal Trade Commission. Using Consumer Reports: What Employers Need to Know
10
NYC Commission on Human Rights. NYC Commission on Human Rights Legal Enforcement Guidance on the Fair Chance Act