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r ~ ~' \ I ~m tl ^ 9 M~ mwm LUNCH <br />Suntlay <br />E MDLOYMENT S'E RVICEf <br />P.O,E3ox 71250•Eugene, OR 97401 '_ Monday <br />PLEASEPRINT <br />EMPLOYEE N E <br />SOCIAL SECURITY N E <br />COMPA Y NAM <br />1 <br />JOB ITE AND/ P <br />~...1. I <br />WEEK ENDING DATE <br />^ASSIGNMENT COMPLETED I~RETURNING NEXT WEEK <br />HAVE VOU HAD AN ON THE JOR INJURY TH~S WEEK? <br />~~] YES IF YES, NOTIFY SELECTEMP iMMED1ATELV. <br />NO <br />Tuesday. ~ .{ •G;~" <br />WetlnesdaY ~ 4 ~(~ <br />" <br />" <br />Thurstlay ~ ~ <br />~ <br />Fntlay <br />$atdrdfly <br /> Hours to n earest quar ter hour.. <br />CUSTOMER <br />SELECTS P ! E)Untldy <br />E'MPLOY~M.ENi SERVI. C'ES <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />PLEASE PRINT i <br />EMPLQY ENAME <br />~ <br />'' 2 <br />.1 <br />a <br />SOCIAL SECURITYNUM~ i <br />U(I <br />C1~- ~~PANYNAM~ <br />~, <br />JOBSITE NAME AN /OR POk <br />u~ <br />WEEK ING DATE <br />~'~ ~/~ <br />U ASSIGNMENT COMPLETED C~RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOR INJURYTHIS WEEK? <br />^VES IF YES; NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />S C <br />EMDLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />Tuesday <br />Wednesday <br />Thurstlay <br />Fntlay <br />Saturday <br />.. OT <br /> <br /> EMPLOYEE <br />_ Icert fy that Ne hourssM1Own represent my told hours orketl tlunrg Ibe <br />'~ week entl lM1et they properly verf etl by the c0enlo by an ttwrized <br />woM1 relat I es were! IeIXemp <br />ra <br />resenlatlve. Also en <br /> ' p <br />y <br />at the G of i ' Sea reverse rMe nl <br />y~ <br />~ <br />. Sigh ur of e' .. .. <br />~. . <br />-~ ~ CLIENT ' <br />'. Werealize. that tb transfer one of Selectemp's employees to our <br /> payroll requires a settlement See reversefor further Information. I <br /> <br /> <br />' hereby cart fy ida[ihe above hours re correct. <br />x fl~(, <br />Sgnah eof SJpervlsor <br /> <br />LL TOTAL p <br />~7 - <br />k <br />~ <br />~ <br /> ~ IY <br />j <br />:. Z "' 1 7 (O <br />JA <br /> ~rde r 'Dale . <br />PY. <br /> <br />START STOP LESS <br />LUNCH - REG <br />HOURS OVERTIME <br />HOURS <br /> <br /> <br /> <br /> J C~ ~.~_ <br /> 3 3c~ ~ ~=~ <br /> <br /> .~,~ ~,~ <br /> <br />' TOTAL TOTAL ~ •1 (/,. A, StJ t/ [ `ZIG- f~ <br />Hours to nearest quarter hoot ~,~ Tllle ' 1 - ~' Dale ' <br />~' ~Montlay <br />^jy~V/~~~ {(- EMPLOYEE NAME <br />SOCIAL SECU RITV NUMBER ~~~ /~ <br />CO PANY NA~E~ <br />_ ~^. <br />JOBSITE NAME ANDIOR PON <br />~r~,1 <br />WEEK ENDING,DATE <br />-;_ ~ - ~f) <br />^ASSIGNMENT COMPLETED [~I RETURNING NEXTWEEK <br />HAVE YOU HAD AN ON THE J081NJURV THIS WEEK? <br />^ YES IF VES, NOTIFY SELECTEMP IMMEDIATELY. <br />N <br />Tuesday <br />Wednesday <br />Tnursdaj <br />Fntlay <br />Saturda <br />START STOP LESS. '.REG:.' <br />WNCH' HOURS. OVERTIME <br />HOURS- <br /> <br /> <br /> <br /> <br /> <br /> }~ ~ ~ ~ ~~ ; <br /> ~J' ~~ <br /> <br />I'Vl( Vl`t'11.L UJC VIVLI <br />REG: HOURS. OT HOURS <br />EMPLOYEE <br />I c t ty ih t the hours shown represent my total hours worketl tlur ng the <br />ek anJ Nat they were properly ve led by the pl' nt or dY an auNor zetl <br />' representallve:'Alsa, any wp~k relaletl lu'es were repot d to Selaclemp <br />al lne time oft ury seer elorfurtn tion <br />`r i <br />Si cure Dye -"'" <br />CLIENT <br />We realize ihat'to transfer one of5electemp's empleyeestd our <br />. payroll requires a settlement See reversefbr further mlormetion. I <br />• hereby certi that the above hours are correct. <br />'- x ll - i F~F...Q. <br />Slgnalule of Supervisor <br />.EMPLOYEE <br />I ce%ity that the M1ourasM1Own represent mylptal hours worked during the <br />k, antl shat they era properly vented by Rte client or W an amhpneetl <br />rep ese tative. Als anywTk related tres were rep,rletl to Seledemp <br />t the tlm ;~nµry SB eve for fu th nb m tion. <br />' Sig tr~ure~PTntp e <br />CLIENT <br />We realiie [hat to transler one of.Selectemp's employeestoour <br />ayroll requires'a settlement. See reverse for tunher mbrmatioal <br />Rereby cerUrythat the above hnursarem act <br />x (1 aji <br />Slgnalur cl5upervsot <br />' ~ TOTAL TOTAL <br />Hours to neares[quarter hour. (r'2,• Title Date <br />' l:IICTOMF.R COPY ' <br />