Safeway Job Application – Fill Out and Use This PDF

NOTICE AND CONSENT 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 from USIS Commercial Services, Inc. (“USIS”) 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 USIS include, but are not limited to: credit reports, criminal records checks, court records checks, driving 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 USIS from public record sources, educational institutions, USIS 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 USIS 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 USIS by mail at 4500 S. 129th East Avenue, Suite 200, Tulsa, Oklahoma 74153, by phone at (800) 331-9175 or by fax at (918) 627-6162.

If any adverse decision with regard to your application for employment with the Company or, if you are hired, during the cours 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 USIS to release consumer reports and/or investigative consumer reports, as described above, 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 USIS 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 USIS 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 USIS or its agents.

NOTICE TO WASHINGTON STATE APPLICANTS OR EMPLOYEES

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

NOTICE TO WASHINGTON STATE APPLICANTS OR EMPLOYEES

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

1/2008