|
• ~~.L,~( I~Y ^F, Sunday 'alnnl r,~ur_ LUNCH HOURS HOURS-. REG HOURS' -'O
<br />E M D L O Y'M E X i S E R V I (E S'~ ~ / !' -
<br />P.O. Box 71250 Eugene, OR'97401t ~Mondey ~, I;V }T nf) ) ' ~'° ~ ' ~ , ~ ~ "
<br />' ~ ~' EMPLOI
<br />Tuestley .7-00 ..j ;O f f ~ ), , ~ I certity met me Hours shown represent i
<br />PLEASE PRINT - weak, ene lM1ai they were properly verifier
<br /> - EMPLOYEE NAME
<br />
<br /> SOCIALSECURITV.NUMBER
<br /> ~N
<br />- --.COMPA
<br />AME
<br />"rrj ~
<br /> WEEK EN ING DATE -
<br />
<br />^ ASSIGNMENT COMPLETED ETURNING NE%T WEEK
<br />HAVE VOU HAD AN ON THE JOB INJURY THIS WEEK?
<br />^ 5 IF YES, NOTIFY SELECTEMPIMMEDIATELY.
<br />C~O
<br />
<br />..
<br />WetlnestlaY ' -
<br />
<br />/ 00'~
<br />
<br />J A
<br />
<br />.; 1
<br />
<br />J .. -::representative,'Also, any work related loll
<br />",:et Iha t m~e of In~,jugry, Sea reveisa for IuAn
<br />, x ~"rf •`G<" .*.G
<br />" Slgnelure otEmployee
<br />
<br /> ' GLIEN
<br />~
<br />m
<br />7
<br />.; Fntley J ~l ~~
<br />~
<br />: ~ `
<br />~ 1
<br />) 4 ~~ .we reabze mei:
<br />varlsrgr dRe:ar s
<br />'(PaYroll regatta a selilament 5e¢ re
<br />h
<br />b
<br />h
<br />ur
<br /> , hereby terllty ti
<br />e a
<br />ove
<br />o
<br />s ar
<br />
<br />~SaturdaY
<br />' r
<br />1'.x~ (. ~ P
<br />;2; Signethr of Supervisor.,
<br />' TOTAL TOTAL ~ ~ J
<br />Hours to nearest quar ter hour 3~,,., ,
<br />T tla
<br /> ..i ..~
<br />:. ,.:<._'. ..~ I ~ ., CUSTOMERCOPY~
<br />SELECT ~ $pntlay
<br />E&D L'0-YMENT~-'S E'R'Y.ECE S.
<br />P.O. Boz 71250 •'Eugena, OR 97401 ~ Montlay
<br />PLEASE'.PRINT -
<br />~Y~t SMPLOVEE NAME
<br />SOCIAL SEC ~ I~ ~~MBER
<br />COMPANY NAME'
<br />fem. _.
<br />JOBSITE NAME AND/OR PO#
<br />WEEK EN ING DATE
<br />^ ASSIGNMENT COMPLETED ^ RETURNING'NEXT WEEK
<br />HAVE VOU HAD ANON THE JOB INJURY THIS WEEK?
<br />^./W£5 IF YES,'NOTIFV SELECTEMPIMMEDIATELY.
<br />I_I NO
<br />Tuesday,
<br />Wetlnesday
<br />Thurstley
<br />Fritlay
<br />$aNmay
<br />'START ,STOP LESS
<br />LUNCH DREG..
<br />HOURS OVERTIME
<br />HOURS
<br />
<br />
<br />
<br />7.cr;
<br />, :.v
<br />~ y'
<br />~
<br />,
<br />/,''l
<br />y Yir)~, $ jC) _ -~
<br />~1'
<br /> 1 ~. ):
<br />~
<br />.'>>yh! j.PO 1 7.y .
<br />
<br />HOURS ~• !'
<br />iE
<br />total hourswwketl tluring ttre
<br />r me client or by en eulbarizetl
<br />5 were repbrletl to 5eledemp
<br />ilarmaliah ~ ' -
<br />clamp s employees to our
<br />ee for further Iniormatlpn. 1
<br />or cl
<br />~.
<br />r'
<br />-~.r~-~,
<br />Date
<br />FOR OFFIC$USF.~ONLY
<br />...REG. HOURS '-' O.T: HOURS ~ -
<br />t.
<br />.EMPLOYEE
<br />~~ I ceatly Net the Hours shown represe I my total hours wo ketl tluring the
<br />" week, antl that they were properly verif etl by me bbent or by en eu0onzetl
<br />represenlat ve Also any work relaletl mlures were reportetl to 5eledemp
<br />' at the 1 me of injury See rev r e For lurher inbrmaHOn.
<br />. Signflture of Employee - -
<br />CLIENT , '
<br />Werealize that to transfer one ol.Seledemp's employees io our
<br />payroll regmres' a settlement. See reverse for further. iniormeticn. I
<br />hereby cerll hat the above hours ar correct.
<br />'xa <<L,r r
<br />Eignalu(e of Supervisor
<br />' ~. :[~OTAL~ TOTAL( (~
<br />Hours to nearest quarter hour ?r~ ~ -' ~112k{/\ 7 `r~l y ~I ~ ~Z' ~ I e'
<br />- - ~'rne Dale '
<br />CUSTOMER COPY
<br />S l CT :. _$antlay
<br />' EM`DLOYME NT SERV6(ES
<br />P.O. Box 71250 • Eugene, OR 97401 ;`; Montlay
<br />PLEASE PRINT ~ "
<br />EMPLDVEE NAME
<br />r
<br />fl "-~ i- /-~- ~.~
<br />SOCIAL SECURITY NUMBER
<br />J ~~~~
<br />COMPANY NAME
<br />L~j !--
<br />JOBSITE NAME AND/OR POq -
<br />WEEK ENDING.DATE
<br />J,7 j~-1j,1~,
<br />^ASSIGNMENT COMPLETED 'ETURNING NE%T WEEK
<br />' HAVE VOU HAD AN ON THE JOB INJURY,THIS WEEK?
<br />^ VES IF YES; NOTIFY SELECTEMP IMMEDIATELY.
<br />ENO
<br />Tuestley
<br />' Wednestlay
<br />Thurstley
<br />Fritlay
<br />Saturday
<br />START STOP LESS
<br />LUNCH REG
<br />HOURS OVERTIME
<br />HOURS
<br /> 1
<br />7.'t v ~ r%° ~ 7 ~~
<br />° ' rh
<br />Y
<br />i' ~ti ~,i~~ ~ r~
<br />1
<br />} JO ~.fu, ~% }",
<br />,
<br />i'„fir, "5'.8^ ' ; f /j
<br />
<br />FOA OI'FICE USE.ONLY
<br />-I REG HOURS OT HOURS
<br />L ~EMPCQY,)rE
<br />I cerlity mat the hours shown represent y t tat hours wbrketl tluring the
<br />eek and lhanhey eep operly verl etl by lh lianto by namnorizeU
<br />repreae tetrve: Also any work elaletl 1 s were reporretl to 5eledemp
<br />al lhet~yfinjury See rey~arse forfudher n rmatibn.
<br />~~SiAnalpreW Employee - .
<br />' ~ CLIENT:
<br />We realize-that to transfer one of Selectemp's employees to our
<br />payroll requiiesa sealamenl. Beereveiselor lurlher information. I
<br />hereby certify/that the above h urs are correct. '" -
<br />x c~P~--.- i~ lr ~-~_
<br />SlgnaNlfH of Supervisor
<br />..., TOT(A'L TOTAL ~f~~/~ a/~~., 2 ,
<br />~ Hours to nearest quarter hour ~ C> / U n-Q-~ (~
<br />The Oata '
<br />
|