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• ~ tl ~~ ~ ~ ® ~®~ START~~- STOP LESS REG ~'~ OVERTIME " ~ POR OFFICE USE ONLY ' <br />C C I'I LUNCH HOURS HOURS REG HOURS O.T. HOURS <br />Suntlay <br />EM-D LOY~ME Ni SEftV`I (ES~ ^~ 3 5 ~~ ~ .. <br />P.O.Box 71250 • Eugene, OR9740T " Monday / ., <br />PLEASE PRINT ~ ~ ~ ~~ ~ _ " ~ -~ ~ EMPLOYEE ~ ' <br />5 I~ ~Q,AOVEE~~~ <br />`y,1` SOCIAVLV ,CUpiTx NUMBER <br />COMPA LJNY N/•A/LMiLE <br />JOBSITE NAM~EjA-N7D/OR /P~O# <br />WEEK E~G..! ~l.y <br />^ASSIGNMENT COMPL/E7TED RETURNING NEXTWEEK <br />HAVE VOU HAD AN ON THE JOB INJURY THIS W EEK?' <br />^ YES IF YES; NOTIFY SELECTEMP IMMEDIATELY. ~~ <br />LYo <br />Tuaatlay ~ ' 3 0 ;.3 !: 7 5 <br />/ ':d cenity that Iha hou shown repmsent my,tmul hours workatl during the <br />'-weekantllhatlheywerepropetlyyadlletlbylheGlenlcrbyanauthorizetl- <br />nldllVe ~ABp dn <br />' <br />Wclk (elat <br />d <br />rted Ip Sa2Clem <br /> <br />5 fepreBe <br />y <br />e <br />luf e6 WBR repo <br />p <br />~ al the Ilme of njury See reverse Ipr l Iher nbrmel on <br /> V ' X (j.~.(~.(P/1I~ /// <br /> <br />Thurstlay <br />~ <br />^~ <br />~ ~ <br />~ 5 "~ Sgnalure ployee' - <br /> . <br />CLIENT <br /> <br />-Fritla <br /> <br />7 <br /> <br />~ <br />~^/~ <br />~ We real¢e9haTto Iransler ono of Selectemp's employees Id our <br />payroll requiresaselllement. See reverse for twther mlormation. f. <br />y • ~ / • hereby certil!that the above hours correct,. <br />i <br />Saturday -' -. <br />' X w~_ <br /> "~ Signetu of Superv sor <br />' <br /> ~. TOTAL TOTAL <br />' ! <br />~~q ~~ /' ,~ 1 Z"Zt0- ~~ <br />`I lJ <br />f`i <br /> Hours m nearest quart er hour 3 <br />~ - <br />Title - Dare <br />.. CUSTOMER COPY <br />", ,. <br />a`:: -, <br />S CT P ,~k ~~day <br />' E:M-0LOYMENT SE RVIC~FS' ~ ~' <br />P.O. Box 71250 %, Eugene, OR 97401 IMoriaay~ <br />PLEASE PRINT <br /> <br />Ida EMPLOYEE NAME <br />~~~r <br /> SOCIAL SE~RLTY,NUMBER. <br /> <br />~~ COMPANY NAME <br />eN ~ avKS <br /> JOBSITE NAM AND/OR PO# <br /> WEEKE DIN~,iATE ' <br />l1 <br />/IVJ <br />//// <br />i <br />TURNING NEXT WEEK <br />ASSIGNMENT COMPLETED <br />^ <br />R <br />E <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />^ ES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />~NO <br />Tuesday <br />Wetlnesdey <br />Thursday <br />Friday <br />Samrtlay <br />START STOP LESS <br />'LUNCH REG. <br />HOURS OVERTIME <br />HOURS <br /> <br />7 3 75 3 ;" <br />~ 3~3 ~ 30 <br /> <br />-? 3 ~ 5 30 <br /> 3 7.5 <br /> <br />POR OFFICE :USE ONLY <br />-REG. HOURS' O.T.HOURS <br />' ~ ~EMPLOYEE.~ <br />I pdrtiy that the hours shown represent my,totel hours workatl tluring the <br />' week, and tl)al Ihey were properly venlletl by the client or by an authorizetl <br />- rep senleriva: Also, any wcrk relaretl Inluries were reported to Selectemp <br />- at lha('mC Of i/nju/r/y/~Sree reverse lorfurther nbrmatlon., ' <br />Sgnature mpldyee <br />CLIENT, <br />' We,realize that to transfer one of Selectemp's employees to our <br />Rayrcll requires-aseltleman[. Sae ~.reverse'tor further inlormation. I <br />hereby certl(y that the above hours are carted.. <br />Slgnatur~ of Supervisor <br />-' ~ TOTAL TOTAL <br />305 rrt~,vt .S~c~ 3-s-cam <br />Hours to nearest,quarter hour. <br />'~ Tltle ~ Date <br />CUSTOMER COPY - <br />