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EMDLOYMENi SEAYI('ES <br />P.O. Box 71250 • Eugene, OR 97401 <br />PI F~SF PAINT <br />1:. <br />1= Suntlay ' <br />Montlay , <br />7"Gb ~:Gb <br />7~ 2'~ <br />Tuesday f110 ,J• <br />Wetlnestlay y I <br />' Thursday 7(fJs! ~`p~. <br />~g~1PLOYEE NAME <br />SO''yC)IAL SECy}URITY NUMBER <br />T ~~ 1 <br />CQ~9PANY NAME <br />JOBSITE NAME AND10R PO# <br />WEEK ENDING DATE <br />... /~ ~ }M1 <br />^ASSIGNMENT COMPLETED C.' ^'RENRNING NE%T WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS W EEK? <br />'t_~5 IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />SELECTEMP <br />E MDLOYMENT SERVE{ES <br />P.O. Rax 71250 • Eugene, OR 97401. <br />PLEASE'PRINT <br />Friday ~~!'W ~,'~'~" <br />Salumay <br />Sunday <br />Montlay <br />~ EMPLOYEE NAME <br />~~ ~~ ~r ~ rc~ fie. IID <br />SOCIAL SECURITY NUMRER~ <br />~~}~~ ~~ <br />.r /+-I ti OMPANY NAME <br />m <br />JOBSITE NAME AND/OR PO# <br />,WEEK ENDING DATE <br />j _ ~.~~. ~~ .. <br />^ ASSIGNMENT COMPLETED QRETDRNING NEXT WEEK <br />HAVE VOU HAD AN ON THE JOB IN,IURV THIS WEEK? <br />^ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />~NO <br />Tuestlay <br />-Wednesday <br />Thursday <br />Fritlay <br />Saturday <br />t~ <br />10UR5 HOURS;.: REG:HOURS O.T. HOURS' ' <br />~~ .. <br />-~ <br />i~ ~r,: <br />I -7: <br />Hours to nearest quarter hour -"rrj,. <br />~• ~ .FOR OPFICE'USE ONLY <br />REG. HOURS ~ O T. HOURS <br />EMPLOYEE <br />I cediy Thal the ho h prase l y l l l h - ketl tluring the <br />week, and That they were,prpperly vet i ed M the dent or tiyan aumorizetl <br />rep esenratrve. Alsq any wo k related I r es were repodetl M Seleclemp <br />al lhelm of inturySee revers for lu that fo ton. <br />X ~ <br />Slgnalure otEmpldyee <br />' CLIENT, <br />We realize that to transfer one af: Selectemp's employees to qur <br />payroll requires aeetllement. See reverse for further informago¢ I <br />hhereby cerlit hat the above h urs arAe correct. <br />x tl `i. ~r~ <br />Signetuq/e~~ol~~5upervisor ~( <br />' ~T~jL., TOTAL ~'e"1 •,' ~ PV <br />Hours to nearest quarter hour I.y~~ -~ cJ ?i -~Z~`~~ <br />.„ roe Date <br />' EMPLOYEE <br />. I cattily that the hours shown represem my local hours viorketl during the <br />-~ weak, antl that they wereproperly vet f etl by the cl'¢nl of by an authodzetl <br />represenlalive: Als any work relatetl mludes were reported to Selectemp <br />' ~ mVthe hme of in.. jury See reverse fur r <br />: 9gneture of Employee ~~• _~~ <br />CLIENT <br />We realize [hat t6 [ransler.one o6. Sele<temp's employees to qur <br />payroll requiies'ase¢lement. See aeveisaior further information. 1 <br />.hereby cerll that the above hours are/Icorrect. <br />Sgnatu of SUpermsor <br />TOTAL <br />' Ltle Date . <br />START STOP LESS <br />.LUNCH REG. <br />HOURS. OVERTIME <br />HOURS <br /> <br /> <br />7'G~ 3: as ,~ ~ 5 <br />I. ub :3G . 5 ~? <br />.? GC.i ~.Gd ,~ ~~,~.. .. <br />~. ou 3; ~o I ~ 'i ~' <br /> <br />CUSTOMER COPY <br />S CT P <br />E MD LDYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401. <br />PLOYEE NAME <br />~ctce{e: I ~~ <br />COMPANY NAME <br />~ ~)Y <br />ATE NAME ANDlOR POW <br /> FOR OFFICE USE-0NLY <br /> START STOP LESS <br />LUNCH REG ovERnME <br />HOURS HOURS 'REG.HOURS OT.HOURS -" <br /> a <br />$untlay <br />{ Montlay <br /> _ <br />EMPLOYEE <br />~ <br /> <br />Tuesday a}~ <br />rQU 3 : ~~ ~} <br />( '. / <br />/~ I cattily Ihat Ne ho rs shov+_n repress t my t tel hours worked tluring the <br />antl lhaflhey we epropedy verfietl byth clienlo by en authorized <br />viaek <br /> <br />/' , <br />''~ representat ve. Also enywork relatetl nI Wes were repodetl to Selectemp <br />uf so iorfulfier- rmallort <br />pl that me o <br />d <br />W q <br />!; o~ 3:~o I , ~ ~ ~ gib. ~ <br />ednes <br />ay X <br /> <br />~ <br />~~ <br />~'.(Xj. <br />I~ 7 ~ <br />r1 <br />f Sign lure of Employee ' <br />~ <br />Thursday . r <br />'. CLIENT <br /> <br />' <br />l' <br />? /1 <br />'' <br />'~ ' We realize that to tiarister one of Seleclemp's employees to our <br />payroll regwr99a55x a setuament. See reverse tar turiher mtormation.l <br />Fritlay ~ <br />OQ 0. <br />J V y ~ hereby^rnfdlhatl~v~oy;<s ere Correct. <br />EEK ENDING DATE Saturday <br />^ ASSIGNMENT COMPLETED If7 RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS W EEK? <br />^ VES IF YES. NOTIFY SELECTEMP IMMEDIATELY. <br />Hours to nearest quarter hour. <br />F-fq:~ 1 <br />.Date <br />