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*Country:
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Educational Profile

    Collegiate Majors Degreed In:
    Professional Certifications:

    Professional Profile

    Salary Requirements:

    Invitation to Self-Identify

    The completion of this section is voluntary and is not required for employment.

    As an employer committed to equal employment opportunity, Safeway monitors data collected from applicants. Providing race/ethnic and gender information is voluntary. If you elect to provide the data, it will be kept confidential and used only in accordance with government regulations.

    Safeway values the diversity of its workforce and the communities in which it operates. We are committed to equal employment opportunity for all applicants and employees, and do not discriminate in any aspect of employment on the basis of race, color, religion, gender, national origin, disability, sexual orientation, gender identity, veteran status, marital status, pregnancy, age or any other legally protected status under state, federal or local laws.

    Availability

    Sunday
    Monday
    Tuesday
    Wednesday
    Thursday
    Friday
    Saturday

    If the answer above question is “yes”, please list for each conviction, the nature, date and city or county of the conviction.

    THIS INCLUDES SELLING OR SUPPLYING TOBACCO PRODUCTS TO A MINOR THAT WAS NOT OVERTURNED ON APPEAL, OR THE RECORD FOR WHICH WAS NOT JUDICIALLY ORDERED SEALED, EXPUNGED, OR STATUTORILY ERADICATED, OR THE CASE WAS NOT JUDICIALLY DISMISSED PURSUANT TO CALIFORNIA PENAL CODE SECTION 1203.4, OR WAS NOT RESOLVED BY A REFERRAL TO A PRETRIAL OR POST TRIAL DIVERSION PROGRAM?

    If the answer to this question is “yes”, state the date and city or county of the conviction(s) and explain the circumstances giving rise to the conviction(s) without identifying the names of any other persons involved in the incident.

    High School

    *Country:
    *State/Province:

    Current or Most Recent Employer

    *Country:
    *State/Province:
    *Resume/Text:



    I here by certify all the facts and information provided by me are genuine and i would like to apply for the above position.

    Tax Credit Screening

    Additional Information

    This company participates in the federal government's Work Opportunity Tax Credit, Welfare to Work, and other federal and state tax credit programs. The information you supply will be used by this company to complete its federal and state tax returns, and in no way will negatively impact any hiring decision. Your responses to the questions will be confidential to the employer's management and federal, state and local agencies

    Have you received a conditional certification from your state employment security agency (SESA) or other participating agency for either

    Must have at least 180 days of active service;- Coast Guard, National Guard and Reserves will qualify for credit;- ROTC does not qualify for credit

    "Service-connected disability" means the disability was incurred or aggravated while in the line of active duty

    Can receive unemployment compensation for any amount of time (does not have to be consecutive).

    Can receive unemployment compensation for any amount of time (does not have to be consecutive)

    Since you answered YES to a previous question, please provide the following if you can

    Must have at least 180 days of active service;- Coast Guard, National Guard and Reserves will qualify for credit;- ROTC does not qualify for credit;- The Supplemental Nutrition Assistance Program (SNAP) is also considered Food Stamps

    Since you answered YES to a previous question, please provide the following if you can

    City and State where Food Stamps were received?

    Cash Assistance could be in the form of: AFDC = Aid to Families with Dependent ChildrenTANF = Temporary Assistance for Needy Families (also known as welfare benefits)

    Since you answered YES to a previous question, please provide the following if you can

    Where were benefits received?

    Deferred Adjudication is a plea bargain in which formal judgment is withheld pending the outcome of a probation period and qualifies as a Yes for this question.

    Operator Note: Deferred adjudication or plea bargain within the past year qualifies for check box -(b)-

    Since you answered YES to a previous question, please provide the following if you can

    This disability must be your own, not a family member's

    Since you answered YES to previous question, please provide the following if you can:
    Where is the facility located?

    Since you answered YES to a previous question, please provide the following if you can

    Where were benefits received?

    Certification and Release Statement

    Please read the important information below about your application.

    1. I authorize the employers and references listed to provide the Company with information about my previous employment and any other information they may have (except information that cannot be obtained as a matter of law). I release all parties and persons, including the Company, from any and all liability for any damages for providing this information, consistent with state and federal law.

    2. I understand that employment for certain positions may be contingent on providing proof that I am of legal age, passing a pre-employment drug screening test, a background check, and a post-offer medical examination, if applicable.

    3. I understand that any false statement or omission on this application may prevent me from receiving an offer of employment, may result in the withdrawal of an employment offer, or may result in my discharge from employment if I am already employed at the time the false statement or omission is discovered.

    4. I understand that on or before the first day of work, I must provide satisfactory documentation that establishes my identity and eligibility to work in the U.S. This legal requirement applies to all employees and is in order for the Company to comply with the Department of Homeland Security regulations for I-9 purposes. This legal requirement must be satisfied within 3 business days from my start of employment.
    5. If I am under the age of 18, I understand that I will be required to provide a work permit or other required work authorization form if required by state law.

    6. I understand that nothing in this application is intended to be, or is, an offer of employment or a promise of continued employment. I understand that if I am employed by the Company, my employment is for no specific term. If hired, I agree to follow Company policies and procedures.

    7. I further understand that, except for any periods of time that I am employed in a position covered by an express written agreement that provides otherwise, my employment with the Company may be terminated at any time, with or without cause and/or notice, at the will of either me or the Company. No Company representative has any authority to enter into any agreement with me different or contrary to this.
    8. I understand the Company, in its sole discretion, may change its existing employment practices, policies, procedures, compensation systems, benefits, and other privileges and benefits of employment at any time, with or without notice to me.
    Please read the important information below about your application.

    1. Information that I have provided on this application is true and correct. Any false statement or deliberate omission of facts will be justification for refusal of employment, or if employed just cause for termination of employment with Safeway without notice.

    2. Safeway may make inquiries to verify all the information provided by me, including but not limited to education and employment, and may use an outside company to conduct the investigation.

    3. I hereby consent to the use of my Social Insurance Number (SIN) by Safeway for the purposes of administering my payroll and employee benefits (and union dues, if applicable). By agreeing to this, I give authorization for the use of my SIN in communicating, as necessary, with benefits suppliers and administrators (and union, if applicable), I understand that they will limit the use and disclosure of my SIN to these purposes and use all reasonable measures to safeguard the confidentiality of my SIN and prevent disclosure to any other parties.


    You must agree to the terms of the Certification and Release Statement to be considered for employment. If you do not, the application process will terminate at this point.

    Notice and Disclosure Statement

    NOTICE CONCERNING CONSUMER REPORTS AND INVESTIGATIVE CONSUMER REPORTS

    This form, which you should read carefully before signing, has been provided to you because Safeway Inc. (“the Company”) may request consumer reports or investigative consumer reports, including, but not limited to, criminal background check reports, from Asurint in connection with your application for employment or, if you are or become employed by the Company, during the course of your employment with the Company. Such reports may be requested for purposes of evaluating your suitability for employment, promotion, reassignment, retention or other employment-related purposes.

    The types of reports that the Company may request from Asurint include, but are not limited to: credit reports, criminal records checks, court records checks, motor vehicle records, and/or summaries of educational, employment records and histories, and investigative consumer reports (reports with information regarding your character, general reputation, personal characteristics or mode of living). The information contained in these reports may be obtained by Asurint from public record sources, educational institutions, Asurint clients, or through personal interviews with your co-workers, neighbors, friends, associates, current or former employers, or other people you know. You have the right to request additional disclosures of the nature and scope of the investigation by Asurint and a statement of your rights. To receive this information or to inspect any files concerning such a report or to determine if a report on you has been requested, you may contact Asurint by mail at 1501 Euclid Ave, Suite 900, Cleveland OH 44115 or by phone at 800-906-2034 or on the web at www.asurint.com.
    If any adverse decision with regard to your application for employment with the Company or, if you are hired, during the course of your employment, is based in whole or part on the information contained in a consumer report or an investigative consumer report, you will be notified as to the basis for the decision and given a copy of the report, as well as a summary of your applicable rights.

    CONSENT TO CONSUMER REPORTS AND INVESTIGATIVE CONSUMER REPORTS

    I have carefully read and understand the Notice Concerning Consumer Reports and Investigative Consumer Reports and this Consent to Consumer Reports and Investigative Consumer Reports (“Consent”) and, by my signature below, I authorize Asurint to release consumer reports and/or investigative consumer reports, as described above, including, but not limited to, criminal background check reports, to the Company: (1) in conjunction with my application for employment and (2) during the entire course of my employment. I further understand that any and all information contained in my job application or otherwise disclosed to the Company by me before or during my employment may be utilized for the purpose of obtaining the consumer reports or investigative consumer reports requested by the Company, and I confirm that all such information provided in connection with my job application is true and correct. I also agree that a facsimile, photocopy or electronic copy of this form may be used in lieu of the original.

    I also authorize the following entities to disclose to Asurint and its agents all information about or concerning me, including, but not limited to: my past or present employers; learning institutions, including collegers and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; all other private and public sector repositories of information; and, any other person, organization or agency with any information about or concerning me. The information that can be disclosed to Asurint and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, drug test results, military service, professional credentials, and all other information requested by Asurint or its agents.

    NOTICE TO WASHINGTON STATE APPLICANTS OR EMPLOYEES

    If you submit a request in writing to Asurint within a reasonable amount of time after you review and sign this document, you have a right to obtain from Asurint complete and accurate disclosure of the nature and scope of the consumer report ordered and the right to ask Asurint for a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

    By selecting "I Agree", you acknowledge that you have read and understood the Notice Concerning Consumer Reports, and that you agree to the terms of the Consent to Consumer Reports and Investigative Consumer Reports (the “Consent”), including, but not limited to, agreeing to authorize Asurint to provide criminal history records regarding you to Safeway Inc.

    NOTICE CONCERNING CONSUMER REPORTS AND INVESTIGATIVE CONSUMER REPORTS

    This form, which you should read carefully before signing the separate Consent to Consumer Reports and Investigative Consumer Reports, has been provided to you because Safeway Inc. (“the Company”) may request consumer reports or investigative consumer reports, including, but not limited to, criminal background check reports, from Asurint, in connection with your application for employment or, if you are or become employed by the Company, during the course of your employment with the Company. Such reports may be requested for purposes of evaluating your suitability for employment, promotion, reassignment, retention or other employment-related purposes.

    The types of reports that the Company may request from Asurint include, but are not limited to: credit reports, criminal records checks, court records checks, motor vehicle records, and/or summaries of educational, employment records and histories, and investigative consumer reports (reports with information regarding your character, general reputation, personal characteristics or mode of living). The information contained in these reports may be obtained by Asurint from public record sources, educational institutions or through personal interviews with your co-workers, neighbors, friends, associates, current or former employers, or other people you know. You have the right to request additional disclosures of the nature and scope of the investigation by Asurint and a statement of your rights. To receive this information or to inspect any files concerning such a report or to determine if a report on you has been requested, you may contact Asurint by mail at 1501 Euclid Ave, Suite 900, Cleveland OH 44115, by phone at 800-906-2034 or on the web at www.asurint.com.

    Pursuant to the California Civil Code, upon submission of proper identification and during normal business hours, you may view the file maintained on you by Asurint. By contacting Asurint in person, by mail or by phone, you also may obtain a copy of this file after submitting proper identification and paying any statutorily-prescribed costs for such file. Asurint is required to have personnel available to explain your file to you and must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you provided that this person furnishes reasonable identification.

    If any adverse decision with regard to your application for employment with the company or, if you are hired, during the course of your employment, is based in whole or part on the information contained in a consumer report or investigative consumer report, you will be notified as to the basis for the decision and given a copy of the report, as well as a summary of your applicable rights.

    CONSENT TO CONSUMER REPORTS AND INVESTIGATIVE CONSUMER REPORTS

    I have carefully read and understand the Notice Concerning Consumer Reports and Investigative Consumer Reports (“the Notice”) and this Consent to Consumer Reports and Investigative Consumer Reports (“Consent”) and, by my signature below, I authorize Asurint to release consumer reports and/or investigative consumer reports, including, but not limited to, criminal background check reports, as described in the Notice, to Safeway Inc. (the “Company”): (1) in conjunction with my application for employment, and (2) during the entire course of my employment. I further understand that any and all information contained in my job application or otherwise disclosed to the Company by me before or during my employment, if any, may be utilized for the purpose of obtaining the consumer reports or investigative consumer reports requested by the Company, and I confirm that all such information provided in connection with my job application is true and correct. I also agree that a facsimile, photocopy or electronic copy of this form may be used in lieu of the original.

    I also authorize the following entities to disclose to Asurint and its agents all information about or concerning me, including, but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; all other private and public sector repositories of information; and, any other person, organization or agency with any information about or concerning me. The information that can be disclosed to Asurint and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, drug test results, military service, professional credentials, and all other information requested by Asurint or its agents.

    In the event that the Company obtains Public Records for purposes of conducting an investigation for suspicion of wrongdoing or misconduct by you, the Company may withhold the information until the completion of the investigation.

    By selecting "I Agree", you acknowledge that you have read and understood the Notice Concerning Consumer Reports, and that you agree to the terms of the Consent to Consumer Reports and Investigative Consumer Reports (the “Consent”), including, but not limited to, agreeing to authorize Asurint to provide criminal background check reports regarding you to Safeway Inc.

    You must agree to the terms of the Notice and Disclosure Statement to be considered for employment. If you do not, the application process will terminate at this point.

    Application Statement

    By clicking on “I Agree” at the end of this application, I understand that I am certifying that
    (a) I have read and understand the information in the Certification and Release Statement;
    (b) I agree to the terms of each and every item listed in the Certification and Release Statement;
    (c) the information I provided on this application is true and correct to the best of my knowledge, and
    (d) I agree to have this information checked by the Company.


    To the terms and conditions above