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"~ SELECTS p <br />.EMDCOYMENT SERYL(ES <br />P.O. Boz 71250 •. Eugene, OR 97401 <br />DI FASF PRINT <br />EMPLOYEE NAME <br />,rvlgl~ (~Cca~eiio <br />S~1O(~CIA~gL SECURITY.NUMBER <br />J ( U <br />COMPANY NAME <br />~ C~ C <br />JOBSITE NAME ANDIOR POri <br />,. EEK ENDING DATE <br />~- -gyp <br />ASSIGNMENT COMPLETED ^RETURNING NEXT WEEK <br />NAVE YOU HAD AN ON THE JOB INJURY.THIS WEEK? <br />~^ Y~S IF YESNOTIFY SELECTEMP IMMEDIATELY. " <br />L7~N0 <br />.t. <br />$untlay <br />Monday <br />Tuestlay <br />Wednestlay <br />Thurstlay <br />Friday <br />Sawmey <br />START STOP LESS <br />LUNCN REG" <br />HOURS OVERTIME <br />HOURS <br /> <br />7.'r~a ~ ~o , ~' 7, s <br />~.un 3. ao I~ j~- <br /> <br /> <br /> <br /> <br />FOR" OFFICE USE ONLY <br />REG. HOURS O L HOURS , <br />EMPLOYEE <br />I tardy that ihedours shown represent my total hwre worked durirg the <br />- week entl that they ere properly venhetl M the Giant or by en aWhonzed <br />ep tabva'Also any wmN releletl I res were reported to Seleclemp <br />' at the m~e/~of njnj~uJr/y~See re se icr iutlher n r etion. <br />Sgnatura of Empoyae <br />CLIENT <br />Wa realize that to transfer one of selectemp's employees to our <br />payroll r~gQulres fl3e111Emen[. see reversefor further information. I <br />hereby ¢~rtify thafthgabove hoyrs are correct. , <br />signelura or supervisor <br />$QTAL TOTAL J _~.~wd~~ ?,.' IAA ( ~~ <br />Hours to nearest quarter hour ~`{f ~ great J '1 - , <br />T Ile Oeta <br />' CUSTOMER COPY. <br />