Fillable Safeway Application For Employment (Page 4 of 5) in pdf

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 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 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.

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 USIS. By contacting USIS 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. USIS 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 USIS Commercial Services, Inc. (“USIS”) to release consumer reports

and/or investigative consumer 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.

1/2008

Safeway Application For Employment Page 4