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.. <br />STARTS ~ STOP eeea ~ ;REG. OVERTIME NUH Ul`h7CE USE ONLY- <br />' ! q <br />'~• .,, LUNCH '. HOURS HOURS ~:~ <br />" F. ,+ REG. HOURS- ~ %' O.T. HOURS ' <br />.,... Sunday <br />EMRILOYMENi $-ERV-I(ES ~ ' <br />PO.Box 71250 • Eugene, OR 97401 Monday ~ffi~'~ ;pp ` jJ ~~~:,~ ~ ~- <br />PLEASEPRINT - - - <br />EMPLQYEENAME . <br />T f:~r... i~ v r ~ f 5., <br />OCTAL SECURITY NUMBER <br />{) COMPANY NAME - <br />(i 'A~ G-vl- lc::~4L~ <br />JOB 1TE~NAME AND/O PO# <br />`I U• <br />WEEK ENDINGDATE <br />e~z 2'~",r"'1~, <br />^ASSIGNMENT COMPLETED n,RETURNING NEXT WEEK <br />HAVE VOU HAD AN ON THE JOB INJURVTHIS WEEK? <br />fES IF YES, NOTIFY SELECTEMPIMMEDIATELY. <br />NO <br />' , EMPLOYEE NAME <br />~ . <br />SOCIAL SECURITY NUMBER <br />.' <br />r. COMPANY NAME <br />JOBSITE NAME ANDIOR PO# <br />WEEK ENDING DATE <br />~a6i 196 <br />i <br />^ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ONTHEJOB INJURY THIS WEEK?' - <br />rl VES IF YES; NOTIFY SELECTEMP IMMEDIATELY: <br />NO <br />Tuesday %' /~ ~ i . ^ "' ~ 0 =I _ S <br />Wednesday ._I, J9, S-7~ ;.'~o 0. <br />Thurstlay l'. J'J ~.Oa ~. 7r~ ~~'S~'_ <br /> <br />$aturtlay ~ ~. ., <br />• '- - TOoTAL TOTAL <br />Hburs to nearest quarter hour O <br />.EMPLOYEE <br />I cerlily that Iha hours shown represent my total hours worketl tluring the <br />w ek antl that they were grope ly verf atlty Me cl'eril or py en auNOrized <br />rapresenl Irve: Aleo y work rat t tl inlur as we reported to Ssl temp <br />adh pme of jury. See /rave IorlmiM1er bmal an.+~ <br />X `Yt t eJ ( y. fa^V A.4~ <br />Sgnature al Empl ee ' <br />CLIENT° <br />Werealize (hal'to transfer one of Selectemp's employees to our <br />payroll rsquirebe selllemant. See reverse tar luriher information.I <br />hereby car ly that the above hours ecortect. <br />x Q ~~' ~~_ <br />S gna[u ISUpervisor <br />Ttfta~1 S~nJ Z-zl<;-i~. <br />The ~ Dale -. <br /> <br />TuestlaV T, n <br />. _Q,a S ~ J. . ., ~ <br />.. J i <br />_ ~J' <br />Jj-> ~ CMIYLUT CC ~~ ' <br />I certify IM1at the hours shown represent my total Hours worked during the <br />weak, and that they were properly varilie0 bylhe client or tiyan eulhorizetl <br /> representellve: Alsp, dny,work relaletl Injuries were repQrletl to Seleilamp <br /> <br />Wednesday `., <br />' <br />)0 <br />l 7 <br />~ <br />.~ gal lhetma of nryry.5a revereel rtudher nfc anon <br />r <br /> i : ,U . . <br /> <br />~ThurstlaY <br />S7 <br />J _ <br />-' <br />, 9 <br />ti ~. S,gnature o(Employee~~ „ <br /> 7 <br />1 . <br /> CLIENT <br /> <br />'Fntlay <br />f i - ~% ~~ ~ 't ~ <br />~~ < .J ,...~ <br />(_~'i ~ We realize: that to transfer one of Seleciemp's employees to our <br />;' payroll requires a settlement See~reve <br />rae far further Information. I <br /> .hereby cerb that the above ho are ortect. <br />g <br />~ <br />'Sawrday ' X t." <br /> 'Sighal aoi Supervisor ~- <br /> TOTAL: TOTAL ~n ~,i ~ I ~ r~. <br />~-^ S - / (;J <br />^a /~ V <br />~1'~ <br /> Hours to nearest quart <br />' er hour 3' g ~ . <br />{ <br />- <br /> I The I f)aie <br />CUSTOMER COPY <br />S L C ~ s~~day <br />~, EMD LOYMENT SE RYICES ' <br />P.O. Rox 7125U • Eugene, OR 97401 Monday <br />PLEASE PRINT <br />EMPLOYEE NAME <br />' ~j ~ (.'.(' f. o r-r I S <br />SOCIAL SECURITYNUMBER <br />"v' Z <br />COMPAN.Y,NAME <br />~JOBSITE NAME AND/OR POx ~. <br />WEEK ENDING DATE <br />~'.~ i ~ ~ ~ 1 r' <br />^ASSIGNMENT COMPLETED RETURNING NEXT WEEK. <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK?' <br />YES IF VES, NOTIFVSELECTEMP IMMEDIATELY. <br />~~ NO <br />Tuesday <br />Wednestlay <br />Thurstlay <br />fntlay <br />Sewmay <br />START, STOP LESS <br />LUNCH PEG.. <br />HOURS OVERTIME <br />HOUflS <br /> <br /> <br /> r n - <br /> <br /> <br />i . ' ~ } <br /> <br />FOR OFFICE USE ONLY <br />REG.HOURS'' O; T. HOURG ' <br />' EMPLOYEE ' <br />I cetllly that the hours shown represem my total Lours worked tluring the <br />week antl that Nay weiep operly verietl by the client or bl'art aWhonretl <br />represental ve Also arty work relaletl I es were repotletlro Seletlemp <br />at the time of inlury 5 rave se br to Ne I aeon. <br />Signature oV Employee ' <br />CLIENL <br />' We realize That to va8sfer one o! Selectemp's employees to our <br />-payroll requites a settlement. Sea reverse. br lurther Information. I <br />here/bny ce Ify that the a/bofnnv[e hfo/ujrs are correct. <br />Slgnat~ire of Rupervisor <br />TOTAL TOTAL V ~ - (Z. "I'C~ <br />Hours to nearest quarter hour ~g: r ~ IIW rI~ 7J~ <br />Tme Daea <br />