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)Ee �� I I SIAHr aloY LUNCH' HOUR HOURS <br />L REG HOURS OT HOURS <br />Sunday' <br />E M P L 0 Y M E N T S E R V I C E S - <br />P.O. Box 71250 •.Eugene, OR 97461 Monday i <br />PLEASE PRINT EMPLOYEE: <br />-,� <br />EMPLOYEE NA <br />' .SOCIAL SECURITY NUMBER. <br />COMPANY NAME <br />JOBSITE NAME AND/OR PO# <br />WF ENDING DATE <br />0 ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />2 NO <br />Tuestlay. <br />Wednesday <br />` (.V <br />�:�IG <br />[I <br />_ <br />cent'that the hours shown represen the total houre wgMed, during lna <br />k end theHhe /wola poperly vadlletl dy the dleniar try authorized <br />represenlabve Also, an wor related Injuries were reported to Selectemp <br />at the t e pi nj Sun revergsku.lurthe fo eon. <br />/ ` l - <br />y % � , <br />� � <br />r t, <br />A. <br />�SOQI L S�ECI�RITV NUMBER - <br />y <br />f: ac <br />,;c7n <br />e t % <br />l�ai9 <br />C MPAN <br />Thursday <br />(ft' / �4.. Eu _ <br />JOBSITE NAME'ANDI R PO# <br />Foray <br />JOBSITE NAME AND /O PO# <br />X r= <br />'ThmsbaY <br />� WP.BK ENgIfyG.DATE ' <br />( /U/ /ekl�ETURNING <br />Saturda <br />SBn4fure of EmMoyee - <br />❑ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURYTHIS WEEK? <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />CLIENT <br />❑ YES <br />[I YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />1 <br />J <br />"Wa reallze that to transfer: one of Selectemp's employees to our <br />Friday <br />y <br />�i�� <br />�1(� <br />-. L <br />- payr requires 'a settlement .See reverse - for further into I <br />_ <br />ereoll <br />hby c t the above h ou are orred..' <br />urbY <br />'$eta <br />x "1"Ll.. k <br />Signature pupservissor <br />TOTAL TOTAL <br />01 <br />! ��PJ 2— ,5 -2c� <br />Hours to nearest quarter hour <br />. <br />Title Date <br />CUSTOMER COPY <br />SR EGEMP Sunday <br />STOP <br />ENPL0YMENT SE RV1(:ES <br />P.O: Box 71250 • Eugene, OR 97401, Monday <br />PLEASE. PRINT <br />.r EMPLOY D AME <br />NO <br />Tuesday <br />� r <br />A. <br />�SOQI L S�ECI�RITV NUMBER - <br />- Wednesday <br />f: ac <br />,;c7n <br />e t % <br />I / � QMPANY NAME <br />C MPAN <br />Thursday <br />(ft' / �4.. Eu _ <br />JOBSITE NAME'ANDI R PO# <br />Foray <br />JOBSITE NAME AND /O PO# <br />' "h 'WTzEK ENDING DATE <br />Saturday <br />� WP.BK ENgIfyG.DATE ' <br />( /U/ /ekl�ETURNING <br />Saturda <br />1 ASSIGNMENT COMPLETED NEXT WEEK <br />❑ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURYTHIS WEEK? <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES <br />[I YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />EMP,60Y�E NAME <br />Tuesday <br />� r <br />A. <br />(g- NO <br />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />EMP,60Y�E NAME <br />Tuesday <br />� r <br />A. <br />S I SECURITY NUMBER <br />rf <br />f: ac <br />,;c7n <br />e t % <br />I / � QMPANY NAME <br />Thursday <br />(ft' / �4.. Eu _ <br />0 <br />JOBSITE NAME AND /O PO# <br />Friday <br />-5;0c' <br />� WP.BK ENgIfyG.DATE ' <br />( /U/ /ekl�ETURNING <br />Saturda <br />1 ASSIGNMENT COMPLETED NEXT WEEK <br />r <br />HAVE YOU HAD ANON THE JOB INJURYTHIS WEEK? <br />❑ YES <br />FOR OFFICE USE ONLY <br />REG: HOURS !' O.T. HOURS <br />EMPLOYEE <br />weedily that the hours shown represent my total hdu <br />weak and t by an eulM1prrzetl <br />during the <br />tat they were property veri M1 e d W the dl enl or by an <br />" mpre6antallve. Also, an wodc relatetl Inlur e6 wa reporletl Selectemp <br />allhetim linjtry lurtherinior _ <br />S i fur Employee' <br />CLIENT'- <br />We realize that to transfer one of Selectemp's employees to our <br />payroll regmr e a setlemenl. See reverse for Wither informal <br />hereby cerl hat me abov rs a correct. <br />X <br />Signal of Supe sor <br />TOT61, TOTAL <br />Hours to nearest quarter hour tie e .. <br />r' Ti Dat <br />CUSTOMER. COPY <br />SE LEGEMP <br />Sunday <br />E' III PL0YNE NT SER "VICES <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />PLEASE PRINT " <br />EMP,60Y�E NAME <br />Tuesday <br />� r <br />S I SECURITY NUMBER <br />Wednesday <br />Q� <br />3,k DD <br />30 <br />I / � QMPANY NAME <br />Thursday <br />(ft' / �4.. Eu _ <br />JOBSITE NAME AND /O PO# <br />Friday <br />-5;0c' <br />� WP.BK ENgIfyG.DATE ' <br />( /U/ /ekl�ETURNING <br />Saturda <br />1 ASSIGNMENT COMPLETED NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURYTHIS WEEK? <br />❑ YES <br />IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />START <br />STOP <br />.LESS <br />LUNCH " <br />"REG <br />HOURS. <br />OVERTIME <br />HOURS <br />o <br />3,k DD <br />30 <br />710 <br />-5;0c' <br />]tea <br />�✓ <br />I Yi] (ti) y y Cif cY ib4 ? [iP L $ J <br />i REG. HOURS OT HOURS <br />EMPLOYEE <br />I certify That the hours shown represent my total hours worked during has <br />week and thatthey were properly verif ad by the client or by wall represa fat verAlso ny work relafetl lu es war report tl Selettemp <br />al lM1etm linty eryvapefor lurlher mlorr ton" <br />3 gne IEmpl <br />CLIENT <br />` We realize that to transfer one of Selectemp'a employees to our <br />payroll requires a settlement. See reverse Tor further information.) <br />hereby call thetto ab hours re comect' <br />X .. <br />S y fSp shearer <br />TOr�TALC�� TOTAL y <br />Hours to nearest quarter hour. 31 0.J (� W ✓ " 'v! yeI <br />T Dale <br />CUSTOMER COPY <br />