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.. SCEP s~nda <br />. E M P L 0 YM E'.N T S E B Y I (E`d ~ ~~ <br />PO Box 71250 • Eugene, OR 97401 ~ Monda~. <br />PI FASF PRINT ~~ <br />' E~M,PLOYEE NAME <br />- SOCIAL3ECURIYV NUMBER <br />COOMPANY NAME <br />JOBSITE ((NAME ANDlOR PO# <br />- ~ WEEK ENDING. DATE <br />~J ao <br />ASSIGNMENT C@APLETED ^RETURNING NEXT.WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />^ YES IF YES,.NOTIFPSELECTEMP IMMEDIATELY. <br />NO <br /> <br />f STOP LESS REG'- OVERTIME -FOR OFFIC$ USR PNLY: p: <br />~ <br />. LUNCH HOURS HOURS REG HOURS <br />i: OT HOURS ~ <br />~ <br /> , . <br />i <br /> <br /> //}~ <br /> ^3 (' `~ /' EMPLOYEE <br /> <br />e -z ~~ ~>] + 7 week and thatlM1ey were propetly verified by thedentorby ana lh rzea <br />re <br />e <br />t I <br />Al <br />l <br />h <br />t <br />d b <br />i <br />d <br />d I <br />S <br />I <br />l <br />; <br /> <br />Ylfedheaday <br />~ <br />~ 3V <br /> <br />~ <br />y ~ <br /> <br />~ C, <br /> <br />~Jr p <br />y wo re <br />ry ies were rel <br />o <br />6e <br />e <br />sp a <br />a <br />e <br />e <br />p <br />e <br />BG <br />emp <br />el lhetme of inryry.5 r se torfurlhe of mat on' <br />, <br />. <br />~ <br /> t`7 {4i°. ra .~ ~:'; ""E <br />~( 5 <br />' <br />,' <br />Thursday ~~,.,~ ~ <br />}~ h , ~ <br /> <br />• ~ <br />~ r' :Signal an(ESnPloy93 t ~ -: <br />t I ::~ ~ ,45~ <br /> ) <br /> <br />~ a ~.`LJENT r , <br />~' <br />Fnday ~ <br />..~ Irv <br />~ <br />r. <br />~ <br />~~ We real¢e Ihet t0 lrapsi~r Ona.Ot RelBCtemp's elhptoyee6 0 our <br />~Gayroll requ res a aetNament +38§',"'reveree for fuftfier ihform~hon I' <br />~'hareby cart ytha(ihe epove hoursare correct + <br />.s <br /> ,, , <br /> <br />' ~ Bgne e <br />oi <br />S <br />uperv sar l ,~ <br /> TOTAL <br />(~~ <br />J~'IZ~7 ~~,~_I/O <br />(~~/ <br />~, <br />f <br />U~ <br />~ <br />Hcursto n~aresiquar ter hour 2 ' <br />"" <br />. <br /> . ~ z ~ ~~ I cetllly Thal the hours shown represent my total hours worketl tlum <br />Title.: <br />Dale <br />CUSTOMER COPY <br />