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• ~~ a ~~ I I®q~ r START ,STOP LUNCH HOURS HOURS REG: HOUR& ' O.T. HOUR& <br />L ~~I Sunday <br />' E-MDLOYME NT ~S"EA YI(E'f ~- ~~ :~1'~' ~ ~~~ <br />P;O. Box 71250 • Eugene, OR 97401 , Monday Gyr • l - <br />PLEASEPRINT !" EMPLOYEE <br />LOYEE NA <br />~°f~vu ~~ <br />SOCIA ~ ECU ITY NUMBER <br />COMPANY NAME <br />JOBSITE N ME AND/OR POa ' <br />~~~,; ; ' <br />E DING DATE <br />,~~ ;~~ <br />L ASSIGNMENT COMPLETED ~ RETURNING NEXT WEEK <br />'HAVE YOU HAD AN ON THE JOB INJURY THIS W EEK7 <br />,YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />-. <br />G~ s.~ <br />/'v <br />)~ (~ I any thaome hou s shown represem my total n ure vorkad aurmg me <br />week antl that they were properly ver lied bythe clam or by an aulUprizetl <br />r es we epotletl to SeleCtemp <br />- re <br />resent <br />Also e <br />work relaletl m <br />0 e <br /> ~ <br />~ p <br />y <br />ry <br />. <br />a <br />~at me Gme ol'nju <br />y~Se reverse lorfunher nfot n. <br /> t= / <br />f y <br /> <br />Thursday <br />~ G <br />~ ~ <br /> <br />~ ~ ~ <br /> <br />J <br />'~ <br />~ ~ signature of Employee' <br />. <br />' ` ~ CLIENT <br /> <br />Frltla <br />v <br />1 <br />/ <br /> <br />~m <br />(''-~ <br />L <br />Jam/ <br />r <br />~ '~ We realrze thab.to transfer one of-Selec[emp's employees [o our <br />payroll regmresa semlement. See reverse for further inbrmatihn. I <br />hereby cerU that the above urs acorrect. <br /> ~m } , <br />Saturtlay <br />3g <br />( <br /> <br />.... <br />. ~ <br />TOTAL TOTAL naW eol SUpeMS <br />r' ' <br />r~(~~ ~~ ~ ~_,. ~~~~~ <br />~ <br />~ <br /> Hours to nearest quart er hour 3~ Tiee - <br />, Dale - - <br />CUSTOMER COPY = <br /> <br />ggqmmm ®®® ppmm <br />" START STOP LESS PEG' OVERTIME <br />' POR OFFICE USEONLY <br />y <br />` .LUNCH HOURS HOURS REG HOURS " OT HOUR& <br />~~~ <br />~ <br />C <br />Sunday <br />S <br /> <br />EMDLOPME AT S'ERVI-LES <br />.r PO Box 71250 • Eugene, OR 9741)1'' Monday <br />~ 9M <br />rrl <br />3p <br /> <br />Y r <br />PLEASE PRINT.... - :- ~- ~ <br />.EMPLOYEE <br />'EMPLOYEFjNAME <br />iT p ~,l ~'f' r <br />SOCIALS Ct1RITY NUMBER <br />~~~~lr <br />' COMPANY NAME <br />~, <br />JOBSITE NAME A DlOR PO# <br />-frU; 7/ } <br />W~/~J/~qyy;X TE ': <br />^ASSIGNMENT COMPLETED !GRETURNING NEXT WEEK <br />HAVE.VOU HAO'AN ONTHE JOB INJURVTHIS WEEK'+ <br />~VES IF YES; NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br /> <br />' <br />' <br />WednestlaY ~~ <br />y}-^ <br /> <br /> <br />1`. <br />T G~i <br /> <br /> <br />~ J <br />~~ , J <br /> <br /> <br />~ f (~ <br />/ <br /> <br /> <br />(7 I certify that ihelhburs shown represem my t t I hours. wtl ked tlur ngJfie- <br />weep aptl ihellhey were properly Vert etl by the cllen4pr by an eWh ttatl <br />crepresBntellve(Alsp any warkrelated lnJu es were reportedlbselec(e5np <br />-. at the gmebtmu_ry SOe rrrarse Qr iunhennto at k; <br />~'~ '1 I N'1""'~ r ~ t,~f <br /> ) j jsypeture el Employee ..a y~~` <br /> r r ` CLIENT <br />: rr - <br />' <br />~~ <br />~ f <br />/' , <br />We realrze that to transier,6ne; of Salactem s~employees to ur I <br />i <br />6~ <br />' <br />' <br />P <br />Fnday r~.;~ ~ ,,.~ rt <br />- thar inlgrmati <br />j..1 <br />. <br />iu <br />"hereby ceQtilfehet the abov~thours a~coee <br />- <br />~ <br /> <br />$aturtlaY , ^ _ ~_ <br />X CI ~~ ~ ~ <br />~' <br /> Sgnalu eof SUperv sor ', <br /> <br />Hours to nearest quarter hour OT~A'LS <br />' ~X TOTAL p~y(~V}~'"y Q <br />"' ~ ~~i ; ~~ ~_ rr~' /~ <br />' <br /> ~ rGle Date <br />' ~ CUSTOMER'COPY <br />~ <br />~~~ ^T ~~ ~ ~ <br />~ 4 P T 'LESS REG. OVERTIME FOR OFFICE USE ONLY <br />e STAR STOP LUNCH HOURS HOURS REGHOURS OT HOURS <br />~ <br />`C <br />SL ~ <br />Suntlay <br />I ~ t <br /> <br />- <br /> <br />~ <br /> <br /> <br />~ <br /> ~ ~ ~ ~ ~ <br />EMDLD'YMENT SE~RYI{fd <br />$O. Box T1250' • Eu aria. OR 97401 ,Monday <br />9 ~' ' ~ ~ °` <br />' ~ <br />tY~,o ~ ' <br />' ~' v ~ ~ <br />PLEASE'PRINT'. ~. .- ~. ". '::... _' ~:! .' ':~ EMP. LOYEE -:.'.: ~~'.':. <br />EMPLOYEE NAMjE <br />1' .. <br />SOCIA4'S~~CU ITY NUMBER <br />,COMPA~ NAME <br />•~ JOBSITE NAME'AND/OR POq <br />f <br />WEEK ENDING DATryryE ~ ' <br />V <br />^ ASSIGNMENT COMPLETED 1~RETURNING NEXT_WEEK <br />HAVE YOUHAD AN ON THE JOB INJURY THIS WEEK? <br />^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />.~..NO - . <br />Tbestlay <br /> <br />} <br />.. <br />Wednestlay ~~_,. <br /> <br /> <br />~ <br /> <br />e <br /> <br />~ <br />rU <br />~ :Y~ <br /> <br /> <br /> <br />[ [ <br />7 <br /> <br /> <br />tP~~~ v <br /> <br /> <br />t iGCemfy mat [M1a ho rs shmvn represent mY total hours wo ked tlupng the.,) <br />v1e~~eM lhaltbey were pmpe ly v6ritled by the clettt ar by an authel etl. <br />r~pre94nlallv Alsq any wD k elated IhI es were rBpprletl to Selememp <br />`atlllatlMg of ln(~S9B (a erne for furthe lnformat pn <br />~~ ~ rf m ti ~~ 1 <br />~~ ~ ~Dt fF <br />.. <br />^7hurstlaY <br />r <br />~ <br />(- <br />~tC lsg awre of Empf Y@b ,t { , <br />t g ,~ <br /> . _ <br />CLIENT <br /> ' We realrze thapto transfer one of Seleptemps employees to our 3 <br />Frltla <br />Y <br />~ <br />~ / <br />( r <br />~. ('' ;payrollrtegm es ~e seUlemenC;See verse for further miormatwn I ~: <br />}e She ab urs cortecl ~ ~ <br />"~ -0ereby Garb I[b <br /> YY <br />' ~ ~ <br />i <br /> :. / <br />X f <br />Saturday "' ' <br /> a Sgnatueof SUperv sor <br />. <br /> . TOTAL TOTAL ^~ ~. <br />' <br />`. <br /> Hours to neatest qua ver hour / ~ ` <br />" Tine. -. ~ Date <br />' <br /> <br />. -o <br />-: <br />. ~1 <br />- . <br /> ~2 t'i- . ~ <br />i t <br />' - :` CUSTOMEF#tCOPY. ,,...,. .. _ - <br />