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____ .,.~ LUNCH HDQRS HOURS is REO HOURS' - OT HOURS " ``, ~~~~L:~C I.tIh.P ,. - _ Sunday~~. 8 RT STD .. .. .. .. , t -. EM'DLOYMENT SERVICES ~ ~ ~ :: ~- P.O. Box 71250 • Eugene, OR 97401 Monday' ' 'EMPLOYEE PLEASE PRINT Tuestlay -~ I caniy That ttn houre shown represem my talel houre worked tlurirq tne- l weak, antl That they were properly venAatl by Iha diem or by en euthorizetl EMPLOYEE NAME r, 1, I SOCIAL SECUR YNUMBER ~' // i COMPANY NAME rte' WEEK ENDING DATE !`.. - ^ASSIGNMENT COMPLETED RETURNING NEXT WEEK HAVE VOU HAD AN ON THE JOB INJURY THIS WEEKS ^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. ^ NO ~represenlellve:Also, arty work ralatetl irijurlee were repor[etl tp Seledemp ,.et dre time of lnlury. See reveree for futlhecinbrmetlpn. Wednesday ~ :r' '.: Sgnetu of Emplbye ~ ' ' ~- r^ _ . _... Thursday. ~ .. ^~-- - -- CLIENT _ _. _. Fntley I -, Saturday . TOTAL 'TOTAL Hours to nearest quarter hour. _ -0USTOMER COPY @~ P w START STOP LESS REG'. OVERTIME FOR OFFICE USE ONLY A I II ~ ~. A \, _ LUNCH ~ NOURS; HOURS `~ REG. HOURS ~ O.L HOURS , C L C Lay/ Suntlay EMDLOYMENT SER~YI<E3 `' P.O. Box 71250 • ~ Eugene, OR 97401 Monday PLEASEPRSNT. - ~ - ~~ ; EMPLOYEE EMPLOYEE NAME' ' i` ' I I . .: ~ ' SOCIAL SECURITY UM ER ~~. ~~ . COMPANYY NAME JOBSITE NAME AND/OR PO# EEh( ENDING DATE r 1 ~ u !(j ^ASSIGNMENT COMPLETED O'RETURNING NEXT WEEK HAVE VOU HAD AN ON TH E JOS INJURY THIS WEEK? ^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. L~ NO Tuesday Wednesday ' Thurstlay ~,~ r= !~ f^ Friday ~ ~~ ~-7 7~ S~ c ,Saturday. 70TAL ~ TOTAL Hours to nearest quarter hour '~ ~~; I cerlily Ihal the hours shown rapresenl my total houre, worketl dudnq Ina aek,antl Nat they, were propeAy veril ed ay the client or by en authbnzetl rep esentelive/Also, any work relaletl j were repotled to Seledemp I the t me of injury See reverse br lur[her nlormaNon: y iv / / Signature of Employee CLIENT We~realize that to [mhsfer one oh.Selectemp'S employees to our payroll requve a settlemenL.See reverse for further information. I hereby cerlily allhe above ho s re corr ct. Sgnalu a of Sup/erv~isor nla Dale CUSTOMER.COPY - r~ t~ s e s Y ~ ~LE5S RE ` OVERTIME 'i'FOR OFFICE USE ONLY - y p p 4 START STOP LUNCH G HOURS HOURS REG HOURS OT HOURS ~ ~ ~ ~ ~ IL „ m I ~ C l $untley r/A , , ~. ,. . ~ `. . : ~ EMDCDYMENi S:ERY'E(ES " .. .' .. . P.O. Box 71250 • Eugene, OR 97401 Monday' - , - EMPLOYEE - ~ Tuesday ~ `~Q ~'C- I cerllty thel the houre shown rapreaenl my Ictal noun workedtlurirp Ipe en eulhorizetl tr PLEASE POINT .? y week antl lhal they were propetly verified by the client or k I retl Inlurlea were re orretl b Seleclam9 EMPLOYEE NAME . 1 _ I I .. SOCIAL SECURITY.NUMBER .. 7 r ' ~COMPANV,NAME WEEK ENDING~DATE I ~% ^ASSIGNMENT COMPLETED '©'RETURNING NEXT WEEK HAVE VOU HAO AN ON THE JOB INJUHV THIS WEEK? ^ YES IF YES, NOTIFY SELECTEMP IMMEOIATELV. ^ NO Wedrtasaay ~ . 5 ;icy ~;~ es, any wor re e p aepresentallve. A 'st the time Mlnlury See raven ar lurlher nbrmallon. ~; ' _ '' x'"r~,/..: ~..,-~ - 51g~ u of EmP Oye T" b'_. I. ' Thursday ~ ~ (~ ~ : f v f , ,. F CLIENT ` `• We reakze thel lo'ttanster one oGSalectemp s employees to pLr ~'F tl ' ~' r ~ r` ~ ` ~ ~ - payroll raqulres,a eettlement.;3ae reverse foLfurlner Inlormetwtl; I re rrect: 1 h a h b ~ n aY . ,/ - i ure e t t e e ove +hereby certify '' /`i X $eturday Slgnatur of Supervsor ' AL TOTAL > OT T / I ~! / J D ~ ~ " 7 '7 ~~ 1 I \ ' a .r~ T _, ~ Houre to nearer[quar ter hour ./r~r l Dete Title