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°'°"1t LUNCM XGURS. nuune <br />' ~~A ~ ~ ~e'.~ ;LREG. HOURS': - ~ OT:HOURS - <br />L Y $untlay <br />EMDLDYMENT~ SE RVI(ES ,, , .-. <br />PO. Box 71250 • Eugene, OR 97401Monday ~ + .. <br />PLEASE PRINT ~ ~ ~ '~ EMPLOYEE <br />' EMPLOVEE.NAME <br />7~' l~r Dorris <br />SOCIAL SECURITY NUMBER ' <br />COMPANY NAME <br />:. 11 ti_ <br />JOBSITE NAME AND/OR PO# <br />WEEK ENDING DATE <br />1, <br />^AGSIGNMENT COMPLETED ~REfURNING NEXT WEEK. <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEKy <br />LVES IF VES,NOTIFY GELECTEMPIMMEDIATELY: <br />ONO <br />Tuestlay <br /> <br />.r ' ~ ~ I cerlily than Ae ho reshown represent my.lptal hours weikedtlurin9 the <br />week, an6 that lh¢y were propery vadlfed by IDe client or M an aufhadzed <br />anywork relbtetl injuries were reported ro Seledemp <br />- represemative <br />Also <br />l <br />Weonestla ~ <br />~ <br />~~ !f! - <br />f '~ j . <br />, <br />al the llme of inlury Bee reverse lorfurfhermNrmation: <br />~ <br />' <br />y 1 <br />X - ' <br />' ~' / Slgnalbre of Employee <br />Thursday ... ~. .. , <br /> ' CLIENT'':. <br /> - We }ealize th t to transfer one of Seledemp'semployaes Id our <br />Frida ~ <br />Y t ,payroll requif ''e seNlement. See revers !or further lntormatian. I <br />cL <br />h <br />l <br />' <br />he <br />o <br /> - <br />va <br />oursare co e <br />hereby cerh <br />y <br />et t <br />a= <br />( <br /> .. <br />, X 7! <br />Saturday ' <br /> <br />~~ , <br />5gn fur of SUpe r <br /> TOTAL TOTAL IE ~t 1 <br />~ <br />( / _ j <br />'~ I~ <br /> <br />' _ <br />~ <br />~ <br />. <br />1 )) V t <br />( <br />Hours to nearest quarter hour ~ <br />~t~ ;'Tile <br />Dale' <br />' <br /> yy~ .4 <br /> d ~ a <br /> t <br /> <br />' CUSTOMER COPY ( <br />j~ ~ <br />) <br />- ~ <br />~` <br />{~ <br />~ <br />START <br />STOP LESS REG OVERTIME FOR OFFICE USE ONLY <br />9 <br />` LUNCH HOURS HOURS REG HOURS"a OT HOURS <br />Y,, <br />Y/ <br />7 <br />S ~ ~ <br />1 <br />~ <br />~ <br />- ~EMPCUY M-E Ni SERVE-(EY <br />P.O. Box 71250 Eugene, OR 97401 Monday <br />~ ~ <br />"~ <br />~;• <br />~,:2+r <br />@ <br />~ , <br />- ~ ' <br />~ <br />~ <br /> <br />~" <br />PLEASEPRINT <br />~ i. <br />'j°'' <br />' <br />^ <br />' ~ `i ~ e <br />f <br />t <br />' <br />-EMPLOYEE <br />~~~ <br />EMPLOYEE NAME <br />T ,Ief .Doff'1 <br />SOCIAL SECURITY NUMBER <br />a3~Z <br />MPANV NAME <br />,CI # Q~ E~ • ~~ <br />~. 08SITE NAME..-A D/OR PO# ' <br />' WEEK ENDINGDATE ~ ' <br />0 '2~s+. <br />^ASSIGNMENT COM~jlETED ~~RETURNINGNE%T WEEK. <br />HAVE YOU HADAN ON THE J081NJURV THIS WEEK? <br />^ YES .IF YES),NOTIFVSELECTEMP IMMEDIATELY. <br />[] NO `` - <br />Tuestlay <br /> <br />" <br />> <br />Wednesday c <br />Iw~V <br /> <br />'- <br />~ .~ ~M <br />,3.W' <br /> <br /> <br />~. %~. <br />- 3~ <br /> <br /> <br />. 3'1.'1 y (~ <br />~ (f]' <br /> <br /> <br />~. '' ~ I cerlily that fhe hours shown repmunt my tmal hours worketl tluring the <br />weak,endlheFthsywereproparlyverfedbyfM1edientortryanaNhorized- <br />representeliva: Also any woM related mrynes ware repo letl to Seledemp <br />of the time allnlury Sea reverse tarfudM1 rormallon: <br /> <br />X ~_ ,:. ., ~ ~.. <br />•~ <br />~ <br /> <br />IThursdaY ~i~ ~.`~ <br />~ 3f`J <br />~i~ Sgnawre of Employee '~ <br />~ <br />CLIENT ~ . <br /> .. <br /> <br />' a <br />(~ <br />O <br />.. Fntlay ~1 <br /> <br />2 ~ <br />~ <br />~ <br />( " We realize that to. haneFer ono of Selediemp's employees td our <br />:' eyroll requirese setllement. See reverse for ~urthar inbrmation. 1, <br />Ihet the above hours aro corcecL ' <br />hereb <br />certi <br />f <br />~ : ~ <br />, <br />1 <br />J r <br />, <br />v _ <br />~ <br />,. <br />y <br />/ <br />~ <br />~$aturtlay : r' /f <br />~ <br />- <br /> `.. 519nat re of Supervisor <br />~ ~ ~ - , <br />- TOTAL TOTAL ( <br />~j <br />I <br />' Hours m nearest quar ter hour ` <br />30 ~J , <br />~, <br />"~1IN'Y 1. ~ ~~ ~ 7 Z- -~~ <br />'The Dale <br />` <br /> <br />- g . <br /> i <br />{ <br />r <br />- - - ~ CUSTOMERCOPY <br />~, <br />~ } ONLY <br /> P LESS REG OVERTIME FOR OFFICE USE <br /> START STO LUNCH HOURS HOURS :REG HOURS OT HOURS <br />T <br />SLC <br />Suntlay <br />E M P L 0 Y M~ E N T S E R Y I (E S ~~ ~ ~`~ _ ~ ~ ~~~ <br />y Mandav <br />P.O. Box 71251) • Eugene, OR 97401 ~ Qp <br />~ ~ t S ~ r~. <br /> <br />- <br />- ~ EMPCOYEE ' <br />PLEASEPRINT -^ ~ ~ Mad ~ me- <br />EMPLOYEE NAME <br />S CIAL SECURITY NUMBER <br />COMPANY NAME <br />- L. <br />JOBSITE NAME AND10R PO# <br />WEEK/ ENDING DATE <br />l ~ ~{, r~ <br />^ASSIGNMENT COMPLETED LJ RETURNING NE%T WEEK <br />HAVE VOU HAOAN ON THE JOB INJURY THIS W EEK7 <br />^ YES IF VES, NOTIFY SELECTEMPIMMEDIATELY. <br />CS No <br />Tuesday ~~'yJ ~b <br />3- <br />\~~~ <br />~s-~ ~ICetlilythel the hours shown represent my.rotabhourswo a unng <br />week, and Mat they were properly verilled byPe client mby an eulh¢rizetl <br />r presenfatl :Also any rk relatetl 1 lures were reported t Seledemp <br /> <br />W <br />d <br />da ' <br />~ <br />)~ _ <br />g at that of njery SOe rev~rsefortui0er of «nalion. 1 <br />~ ~ ~ F' <br />e <br />nes <br />y ~.. ~ (~ . X <br /> ' Signature of Empla%ee - <br />'Thursday ~0~ ~ <br />3 ~ <br />k 5 <br />1a5 - <br />CLIENT' <br /> <br /> <br />'Fdtlay <br /> <br />~~ <br />Z7 <br />~ _ <br /> <br />S ' We realze that to Irensfar one of Seledemp's employees to our <br />•. payroll requlres2 setllemenl. See reversetor fbrther mlormetbn. I <br />hours are correct. <br />ty that the above <br />hereb <br />car <br /> ! ~ //y <br />~4J <br />f <br />~, <br />~ <br />~~ <br />~ <br />$aturtlay . <br />(, <br />X l~ <br />S gnat a al Supernsw , <br /> - - ~ TOTAL TOTAL _ [ ,` <br />N~ ~U~~~ ( ~z.J` ~V <br />1~~ <br /> Hours to n earest quarter-0ouc <br />"~' ` ' <br />Tllle ~~ Dale <br />CUSTOMER COPY - , <br />