New Search
' ~ ~~ Htb HV VH.I. <br />t~.. .SuntlaY . -.... <br />. ~tLt~ I t~l~ <br />• EMDLOYME NT SERVICES' <br />P.O: BoX 71250• Eugene, OR~97401' ~ Manaey <br />EMPLOnVEE NAME_ <br />SOCIA6SECURITY NUMBER <br />`y' f <br />'COMPANYj/NAME <br />{/ t <br />1~ A <br />', JOBSITE NAMEAN~/OR PO#• ' <br />.. 1t.i .. <br />- W~E7EK ENDING'DATE <br />^ASSIGNMENT COMPLETED uLRETURNING NE%T WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS W EEK? <br />^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY: <br />NO <br />Tuestlay <br />Qi?t <br />- ~p.x, <br />`- ~ <br />-.I _ ~ <br />/ '~ I cart ly that Re Hours sl <br />week flntl mapney were <br />rep esemat Ve Alw any <br /> <br />Weadaatlay <br />~ is-' <br />. <br />~ <br />~ <br />' ~.A <br />l <br />hB t me of Inlury. S~n2 <br />, <br /> ~ <br />~~, , . , <br />, <br />' <br />'. <br />Thurstlay <br />~ <br />`f ~Sgn 1 a fEmplayee~;. <br /> <br />-~~Frltla <br />Y r/ I:, <br /> <br />fir} ~~~' <br /> <br />..L <br /> <br />~~ ~lWe,r§211Ze`lhat~~[p ire <br />ipayroll requires e'S2t[ <br />.hereb~r cernry that the <br /> <br /> ' <br /> <br />y Slgnelu b(BUperv sar <br /> ' <br />'~ TOTAL• TOTAL / <br /> <br />Hours loneerest quarter <br />hour ) <br />) + y/ fj <br />L(n~yy{ ~ <br />~Tn"~f <br />' ":r - <br />i_ <br /> <br /> <br />oats <br /> <br />' ~ CUSTOMER.COPX <br />^ ~~ ~ START STOP LESS REGL OVERTIME FOR <br />C L F LUNCH HOURS HOURS REG HOURS. <br />Ia`y Sunday <br />EMDLO.Y M.ENE SERVICES "{~ ~ <br />P.O. Box 71250 Eugene, OR 97407 Monday ~~~ 1 P~'17 ) J <br />PLEASE PRINT '~ ~ / "~ /` _ .~ ", <br />PLOYEE N ME ~' Tuestlay T,' ~ ~ t -+" ! I sentry Thal ihBdours sl <br />' ,1~~ 4(i •'~ ~~"' f f; I ~ r~ :week anp (het;tney wgiE <br />', .ro,/~i 6 ~~7~i ~ .. '."reareaehtau9a:Nip; env <br />SOCIAL: E URI ~ ~1~/NUMBER ' ' <br />..~,'1 <br />r ~~ OOJxAPANV NAME <br />~,~' <br />JOBSITE AME ANq/OR PO# ~,~ <br />~~ ~ / /( <br />WEEK ENDINO. DATE <br />^ASSIGNMENT COAIPLETEO Y_?RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />_ NO <br />EMPLOYEE NA E " <br />SQCIA~SECURiTY NUMBER <br />CO/MPANY NAME <br />C ~i ~ , <br />JOBSITE~/ME AND/OR PO# <br />rfG~ <br />' WE~K ENDING.DATE - <br />_j/'3/~lu <br />^ASSIGNMENT COMPLETED RETURNING NE%T WEEK <br />- HAVE VOU HADAN ON THE JOB INJURY THIS WEEK? <br />^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />T HOUI <br /> <br />.. -.. vur <br />'• Wa raelrze that to transfer one~pi Geleclemp s-emplo eee f0lour i. <br />Fritlay ~ ` ~~ `'Payroll regwres. a seBlament Sea reveese~tor tdrther Informelbn I;: <br /><<A'r'Y1 _J (t ereby can .,,that i-he-7a-hove /h/ou(r`/s,,are rprorrect ~' <br />: SBnatu of SVpervisor / <br />TOTAL TOTAL /, I rl V ~ S.Jfn ~ S f <br />Hours to nearest quarter hour ~ ~ Titl/`U•We --r~0ate <br />Tuestlay <br />' <br />-~ <br /> <br /> <br />WetlnesdaY ~ <br />' f~~ ' <br /> <br />`I <br /> <br />y ',. <br />'GfYh~'. 7 ~ <br />~,,, n <br /> <br /> <br />t <br /> <br />~ I. <br /> <br /> <br />: r <br /> <br /> <br /> <br />t r ', <br />~ ; <br /> <br /> <br /> <br />`x ~ <br />~ S' -: I ca t ly that the ncB[s snows repreyenl my total hours wo ketl tlyrOB Ina I <br />.weel5 Q d IhBt tnBY y+Bra p op ly VariLetl by the dent ar by an pulnzed 1 <br />!represBtltatM Also nny WOM elatod nN swee pwletl lg6el t p <br />ann tmOONy ur p$ae reverse lorturNerinbrmanon . <br />L.,Y N <br />rY."' i<, tF~/~7~~J 'n <br />A <br />.' X ~i•Yi ,.~.+ .PLC sx'~( rl ~ <br /> I <br />~ d Y,•. y <br />6190alma oh EmPlcy~Bt e> <br />~ <br />Thursday <br />" .' 1 <br />»(, <br />~4r*,,: t'L. ~'~ ~ <br />7 7l <br />t r x i ': <br />T <br />t ~ <br />CLIEN'~ :• 5 <br /> . <br />`rWe reahze ihat'to transfer one of 591act~mp s emplpyees our + <br />_ Fritlay ~ 7 <br />~ ~ '7 r' <br />' (Payroll regwres'a seitlemenfi Sea raversB BJf"Wither rotor Ion I <br />S are wrract <br />`he <br />eb <br />ce <br />rh <br />f <br />th <br />t the ab <br />ov <br />e <br />houY <br /> G71'>7" „)fn, x ) f . ., . <br />y <br />a <br />r <br />Y <br />( <br />/ <br />~ <br />Saturday. . <br />` } <br />/! <br />/ <br />E <br />~ <br />/ <br />/ <br />( <br />j <br />y <br />~ <br />X jl ' '_"" ti. Lya~"~, - <br /> ',! Sgnat re of Supervisor <br /> .. .. TOTAL TOTAL _ <br />f <br />/v <br />~ <br /> Hours to nearest quarter ho ur ~ ~ Oat <br />~ <br />~- <br />The <br /> <br />- CUSTOMER COPY <br />