®

Application for Employment

PERSONAL INFORMATION
Name:
Address:
City: Prov: Postal Code:
Home Phone: ( ) Cell Phone: ( )
Are
Are you
you legally
legally entitled
permittedto to
work in Canada?
work in Canada?
YES NO ProvideSocial Insurance
the first Number:
three numbers only of your Social Insurance Number (First
__________________
three numbers only)

Have
Have you ever
ever been
beenemployed
employedbybySafeway
Gardenor Market, IGA, company
any Sobeys Price Chopper, Thrifty
including Foods,
Sobeys, FoodMarket,
Garden Town, Western
IGA, PriceCellars,
Chopper,
Safeway WineFood
Thrifty Foods, & Spirits,
Town,Safeway Lucerne
Sobeys Liquor, Foods,Liquor,
Safeway MacDonalds
SafewayConsolidated
Lucerne FoodsororSobeys?
Macdonalds Consolidated?

YES NO If yes, give: Date______________ Position_____________ Location________________

EDUCATION BACKGROUND
High School College/University
Circle Highest Level Completed 9 10 11 12 13 1 2 3 4 5 6
Other:
Are youcurrently
Are you currently attending
attending schoolan
oreducational institution?
any educational institution? No Yes, Full Time Yes, Part Time

WORK HISTORY
List previous employersininconsecutive
List employers reverse chronological order, beginning
order, beginning with yourwith your or
current current or last employer.
last employer.
If you are presently
If you areemployed
presentlymay we contact
employed mayyour
we current
contactemployer for aemployer?
your current reference? Yes No

Company Name:
Address: City: Prov:
Telephone: ( ) Position Held:
Dates of Employment: (mm/yy-mm/yy) to
Name and Title of Supervisor:
Reason for Leaving:

Company Name:
Address: City: Prov:
Telephone: ( ) Position Held:
Dates of Employment: (mm/yy-mm/yy) to
Name and Title of Supervisor:
Reason for Leaving:

Other reference if different from above:

Name and Title:
Telephone: ( )
Position Applied for Second Choice of Position Date Available to Begin Work

POSITION
What areas interest you (for store INFORMATION
positions)? & AVAILABILITY
q BakeryApplied
Position q Meatfor q Deli q Produce Second
q Grocery Front
q of
Choice End Service
Position q Other______________________
Date Available to Begin Work

SUNDAY
What areas interest you (for store MONDAY
positions)? TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

q Bakery
From Meatq Deli
qqMeat q Deli q Produce
q Produce q Grocery
q Grocery q CashierqqFront End Service
Starbucks q Other______________________
/ Tim Hortons q Other_________________
To
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Do youFrom
have any illness, disability or physical limitations which could prevent you from regularly lifting or
carrying 9 kilograms?
To
If yes, please explain:
YES NO
Do you have any illness, disability or physical limitations which could prevent you from regularly lifting or
carrying
Do 9 kilograms?
Areyou
youhave
able any illness,
to fulfill thedisability
requirementsor physical
of thelimitations which could
job (e.g. regularly prevent
lift and you from
carry heavy doing
items work
(9 kg / 20oflbs)
a repetitive
and to
nature?
do work of a repetitive nature)?
If yes, please explain:
YES NO If yes,
no, please
please explain:
explain:
YES NO
Do you have any illness, disability or physical limitations which could prevent you from doing work of a repetitive
nature?
Have you ever been convicted of an a criminal
offenceoffence
against against
propertyproperty
rights orrights or a fraudulent
a fraudulent transaction,
transaction, including
including theft,
theft, robbery,
robbery, breachbreach
of NO
trust, If yes,
of fraud,
trust, pleaseforgery
fraud,
forgery explain:
or falseorpretenses?
false pretenses?
YES
If yes, please provide the
YES NO
date(s) and nature of
Have you ever been convicted of an offence against property rights or a fraudulent transaction, including theft,
the offence(s):
robbery, breach
Do you have anyoffamily
trust,member
fraud, forgery or false
or common lawpretenses?
relationship who is currently an employee of Safeway or any
Are youcompany?
Sobeys related to, or in a common lawprovide
If yes, please relationship
the with anyone in Safeway’s employ?
YES NO date(s) and nature of
If yes, please advise this
YES NO the offence(s):
person’s job title or
classification:
Are you related to, or in a common law relationship with anyone in Safeway’s employ?
If yes,onplease
(1) Information that I have provided advise this
this application is true and correct. Any false statement or deliberate omission of facts will be justification
YES NO
for refusal of employment, or if person’s
employedjob justtitle
causeorfor termination of employment with Safeway without notice.
classification:
(1)Safeway
(2) All information
may make that I have to
inquiries provided
verify allonthethis application
information is truebyand
provided me,correct.
includingAnybutfalse statement
not limited or deliberate
to education, omission
employment andofreferences
facts will
be justification for refusal of employment, or if employed just
from former employers and may use an outside company to conduct the investigation. cause for termination of employment with Safeway without notice
(1)
(2)Information that I have
I hereby consent providedmaking
to Safeway on this application
any inquiries is true and correct.
to verify all theAny false statement
information or deliberate
provided omission of
by me, including butfacts
notwill be justification
limited to
(3)
for I hereby consent
refusal ofemployment
education, to the
employment, and use of my Social
or if employed
referencesjustInsurance
fromcause Number (SIN)
for termination
former employersofandby Safeway
employment for
may use an the purposes
withoutside
Safeway of administering
without to
company notice. my payroll and employee
conduct the investigation
benefits. By signing
and I hereby this to
consent application, I give authorization
those persons disclosing such for information
the use of mytoSINSafeway
in communicating, as necessary, with benefit suppliers and
(2) Safeway may
administrators. I make inquiries
understand that to verify
they willall thethe
limit information
use and provided by
disclosure of me,SIN
my including
to thesebutpurposes
not limited
andtouse
education, employment andtoreferences
(3) I hereby consent to the use of my Social Insurance Number (SIN) by Safeway for the purposes ofalladministering
reasonable measures
my payroll safeguard
and
from
the former employers
confidentiality
employee benefits.of my and
By SIN may use an
and prevent
signing outside company
disclosureItogive
this application, to conduct
anyauthorization the investigation.
other parties. for the use of my SIN in communicating, as necessary, with
benefit
(3) suppliers
I hereby consentand administrators.
to the use of my SocialI understand that they
Insurance Number (SIN)will
bylimit the use
Safeway andpurposes
for the disclosure of my SIN to my
of administering these purposes
payroll and use all
and employee
reasonable measures to safeguard the confidentiality of my SIN and prevent disclosure to any other parties.
benefits. By signing this application, I give authorization for the use of my SIN in communicating, as necessary, with benefit suppliers and
administrators. I understand that they Applicant’s
will limit the use and disclosure of my SIN to these purposes and use all reasonable
Signature Datemeasures to safeguard
the confidentiality of my SIN and prevent disclosure to any other parties.
For Office Use Only
Store____________ Position________________
Applicant’s Signature Interviewed By___________________
Date

Reference check by_________________

For Office Use Only
Safeway.ca/careers
Store____________ Position________________ Interviewed By___________________
Reference check by_________________
Safeway.ca/careers