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• ~`~~`~ I~~tl^E - J
<br />EMDLOYMENT SE AVI(ES
<br />P.O. Blix 71250• Eugene, OR 97401 '
<br />DI FACE ORWT
<br />EMPLOYEE NAME
<br />%'`~~~I ~- p~curc~~o
<br />.SOCIAL SECURITY NUMBER
<br />3~' ~
<br />COMPANY NAME
<br />~G~~
<br />JOBSITE NAME AND/ORS
<br />~E~i!
<br />WE KENDING DATE
<br />-a7`rn
<br />^ASSIGNMENT COMPLETED ETURNING NEXT WEEK
<br />HAVE VOU HAD AN ON THE JOB INJURY THIS WEEK?.
<br />^V IFYES, NOTIFY SELECTEMPIMMEDIATELY.
<br />LSV NO
<br />y~~ ~SL:C P. ,~ .k _
<br />~~~ E;N'6 LOYMENT S'E RYE(~E.S ,
<br />P.O. Box 71250 • Eugene, OR 97401
<br />PI FACF DRINT ~ '
<br />EMPLOYEE NAME
<br />,Ma 1~} ' ~`ccule 110
<br />-SOCIAL SECURITY NUMBER
<br />.~
<br />COMPANY NAME
<br />C' C~,
<br />JOBSITE NAME AND/OR PO#
<br />qq~ .WrEEK ENDING.OATE '
<br />J ~W ~OQ
<br />^ASSIGNMENT COMPLETED ETURNING NEXT WEEK
<br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK?
<br />^ Y 5 IE YES, NOTIFY SELECTEMP IMMEDIATELY.
<br />NO
<br />T -. , ~ ___.~.
<br />x
<br />SELECTS
<br />E M D' L O Y M E N.1 S E A V I (E i
<br />P.O. Bax 71250 + Eugene, OR 97401
<br />PLEASE PRINT
<br /> START STOP
<br /> LUNCH. HOURS HOURS':
<br />REG
<br />HOURS
<br />O
<br />T
<br />HOURS ~ "
<br /> . .
<br />.
<br />$untlay
<br /> -
<br />
<br />Monday I'qo ? ,~,
<br />~
<br />~ ~ 7 5
<br />
<br />Tuestlay '} {1
<br />/ ,,11
<br />~
<br />'w
<br />~ 7 '~T/
<br />/ ~ / EMPLOYEE .
<br />~ I dedity That the hour6 shown represent my [oral hours worked dunhglhe
<br /> ~ ,
<br />, eek antl that itiey were properly vent etl by the client orW an autticdutl
<br />r es e e re
<br />orted to Selectem
<br />~ re
<br />nt
<br />ti
<br />e
<br />Also an
<br />woB relalatl In
<br />
<br />
<br />WetlnestlaY
<br />~(yw~
<br />~Oiw
<br />y~~`
<br />J.~(,) • ~
<br />
<br />.
<br />~ p
<br />p
<br />a
<br />v
<br />.
<br />y
<br />ry
<br />p
<br />enhe ti~ Inlury ~
<br />~~reversY.for (urthar n
<br />Se/a
<br />~.
<br /> ` '
<br />/
<br />~
<br />X ~'~ !/°"'^'
<br />
<br />ThurstlaY ~} (
<br />~~
<br />/ -y +,,aa~1
<br />~,3 fVU
<br />~
<br />7
<br />~ Sgnature of Employee
<br /> ,( Y 1 'CLIENT:
<br />Friday Jny
<br />1'. , 4L~ 'j ,,tt'',,
<br />} . W r y
<br />. , JJ We realize IM1atlo transfer one ot,Selectemp's employeesJo our
<br />payroll requiresa Settlement See reverse for further Information. I
<br /> hereby c
<br />er
<br />`l~y that the above hours ere correct.
<br />t(i
<br /> g
<br />~
<br />/
<br /> Sgnea of Supervisor
<br />
<br />Hours to nearest quarter hour TOTAL
<br />~~ TOTAL l' t q
<br />-/~~~+- Sr~n,~ Z''Z~~I(J '
<br /> T tie na[9
<br />.'.$untlay
<br />Monday
<br />Tuesday
<br />Wetlnestlap
<br />Thursday
<br />Friday
<br />Sawrtlay
<br />START STOP LESS
<br />LUNCH. REG '
<br />HOURS. OVERTIME
<br />HOURS
<br />
<br />71rno 3:~ I~ ~; ~,
<br />~GKS 5:jd 17 , ~,
<br />T Gcs ,3,'4d , ~ ~, 5
<br />Ted 3:a~ , 5 ?
<br />
<br />
<br />' IQU IPIJ~J
<br />Hours to nearest quarter hour. J
<br />COPY
<br />$untlay
<br />Monday
<br />,~~{ ~~- E~C CaN/e 1 ~~°
<br />S¢QIAL SECURITY NUMBER
<br />-- L CObr7M__ANY NAME
<br />JOBSITE NAME AND/OR PO# ".
<br />WE KE~DING DATE
<br />3~~ ~rv€o
<br />^ ASSIGNMENT COMPLETED RETURNING NEXT WEEK
<br />HAVE VOU HAD AN ON THE JOB INJURY THIS WEEK?
<br />~~~,Ir~'.ES IF YES, NOTIFY SELECTEMP IMMEDIATELY.
<br />L'1 NO
<br />TuesUay
<br />Wednesday
<br />Thursday
<br />Fdtlay
<br />$alurtlay
<br />START STOP LESS
<br />LUNCH REG'
<br />HOURS DVERrIME
<br />HOURSI'
<br />
<br />'] ff~~
<br />/, ,V~ .~~~ l~ ~./f~
<br />7~~~ 3't!o ~ ~ '1,rj ,
<br />
<br />~.Ud ~~~ t ,.'f
<br />~;t1a 3~ad ~
<br />
<br />REG. HOURS ~- O.T.HOURS
<br />EMPLOYEE
<br />I ce try meLthe hou s shown represent mylotel hours wd ketl tl ng the
<br />eek nd ihal they we p party var t tl by Ih client or bye a Ihoi zed
<br />epresenlatve. Also nywprk related lu e e e repo [etl.lp Sel damp
<br />-at the tl`m of mlury See rse tprfunher nrormation.
<br />X :%~~C~~~v'
<br />Signature of Employee '
<br />CLIENT
<br />We realize that to transfer one of Selectemp's employees to our
<br />',. payroll requires'a settlement. Seerwerse for Further information. 1
<br />hereby cart) that the above hours era correct.
<br />~wS~r~J ~-5-
<br />Date
<br />FOA OFFICE USEONLY'
<br />EMPLOYEE
<br />I cerllty that the hears shown represent my mtal hours w k d tluring the
<br />eek and that they eeproperN verd ed bythe dlent or by anauthorizetl.
<br />p esental ve.'Also any wade related nlur es re reporetl td Selaclemp
<br />al thatrVgol ln'ury~r for tunher rmahon.
<br />X //%~//g
<br />Signature of Employee
<br />CLIENT
<br />We reallEethat to lransler one of Selactemp's employees to our
<br />payroll requires a'settlement. See reverse For further Inbrmaaon I
<br />hereby cent that the above hours are correct.
<br />Xn~l_ f~~
<br />;9natye of sapervlaor
<br />~OTAL 'TOTAL ~ ~ P_J.
<br />Hours tp nearest quarter hour. ((ooh ~,y rt'. ~ ' ,y ~. r Z ~C~
<br />T'Ue Oete
<br />CNSTOMER COPY
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