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~ <br />~ <br />( ~ p <br />~~ <br />. <br />v <br />Da t~ Sunday <br />^ <br />~• EMDLOYME NT fE RYI(FS <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />DI FACE DRINT - <br />EMPLOYEE N~,A~M~•E~` <br />~~ ~C:t~~ ~5~"uiY~ <br />SOCIA SECURITY NUMBER <br />~~~~ <br />COMPANY NAME <br />BSITF NAME ND/OR P,O# <br />FT,EK ~ ¢pDING DATE <br />R~ ~+ <br />^ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE VOU HAD AN ON THE JOB INJURY THIS WEEK? <br />^ `/ES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />^ NO <br />SELECTS P <br />EMDLOYME NT SERYI(fS <br />P.O. Box 71250 • Eugene, OR 97401 <br />or epee RRINr <br />EMPLOYEE Jy9 E ...i <br />~4cA ~~,N ~> ~ ~-~ <br />OCTAL SECU TTY NUMBER <br />~~ ~~ <br />COMPANY NAME <br />JOBSITE NAME ANDIOR PO# <br />W - EK'HIDING DATE <br />~~ <br />^ASSIGNMENTCOMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURVTHIS WEEK? <br />^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY: <br />^ NO <br />Tuestlay <br />~Wetlnestlay ' <br />Thurstlay <br />G <br />Fhaay ' <br />$aturtlay <br />Sunday <br />Monday <br />Tuestlay <br />Wetlnestley <br />Thurstlay <br />Fritlay <br />Saturday <br />STOP LUNFH'l HOURS Hf <br /> .^x µ <br />/, <br /> ~ z <br /> ~ } 6~F . <br /> <br /> I ""l~ <br />_ Hours to nearest quarter hour. <br />HOURS,. <br />EMPLOYEE <br />I cart ty That the hours shown represent my total hours worked tlunnq Eh@ <br />eek end that they.. ere properly varl tlby the Giant or by Ihodze <br />representatlva: Also any work relaletl I ry es were reppdetl to ~eledemp <br />at the lame f njury See reverse for W th nlonnalion. <br />.i k <br />J( ~ ~~ 1d xx, 'q <br />SgnaNre ~mployee , <br />CLIENT <br />VJe realizeffief to 6ansler aria of Selectemp's employees 9o our <br />payroll requires a setlement. Sea reverse for further mfprmation. P'. <br />hereby certll hat the above hou s are correct. <br />X ,~- C;~..~-- <br />Signatute of Supervisor <br />nqe Dale <br />`EMPLOYEE. <br />'~ I certify that me hours shown represent my total hours worked tluring the <br />week antl that theyweie properly varil ed by the client dr by an euthorizetl <br />` rep esa tativa. Also any work related nlu ere reDOrleG tp Selenemp <br />' aVl the time of injury. See reuersp rorfud!hert lnlormat on.~ <br />Sgn t at ~ loyee !~ /~ <br />CLIENT <br />Weiealize that, to lransler one oP Selecternp's employees to dm <br />payroll requires a settlement Sea reverse for tunher information. I <br />hereby certil that the above hours a coned. <br />x Cl %- C~~--~- <br />SrgneNrN at Supervisor <br />TOTAL TOTAL <br />Hours to nearest quarter hour -3a ~' ~ "•• ` ~v~~ [.~ " I Z ~,E~ <br />. Tula Oate <br />CUSTOMER <br />START STOP ~ LESS <br />LUNCN 'REG~ <br />HOURS: OVERTIME <br />HOURS- <br /> <br />~ ~ ~ 75 <br />~, 'J ~j 7~ <br /> <br /> 3 .5 ~' . <br />7. ~ '.~ ~'.~. ;. <br /> <br />.. ~y a e ~ ~ .tl py~ ^ V ._ wnun nouns e m .. REG~Hf <br />C YLC CI~I "'$unday <br />E M D L O~Y.M E N i S~E~R V 14~E S , <br />P.O. Box 71250 Eugene, OR 97401 + r _ Monday <br />PLEASE PRINT ~ - ~ ~ .., ,. <br />EMPLOYEE NAME <br />e ;51~ <br />SOCIAI: SECUR~I[TY-NUMBER' <br />~~!~.~ <br />'~COMPANY~NAME <br />,JOBSITE NAME AND/OR PON <br />~~G' , tu\ `i'vn,`Y~ , <br />' ~ EK ENDING.DATE <br />~. <br />^ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />^ YES IF YES, fJOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />i ,; <br />_ ~. OT HOURS ~,;.. . <br />, r ;,. <br />. ~cnn Dl nvaR ' <br />slgnamrgar aupervlsor. ' <br />.~ <br />