Grant 673 Final Report - Laserfiche WebLink

New Search

SLLK I EMP SOCIAL SECURITY NUMBER REG E MP L0YMENT SERVICES P.O. Box 71250 • Eugene, OR 97401' PLEASE PRINT WEEK EN ING DATE �IAHI OIUY I'f $unday , �y „ Q Mande: !'+, /"� O V1 0 0 Du EMPLQ;EE NAM STOP SOCIAL SECURITY NUMBER REG t p i f COMPANY NAME 1 eu er1 JOBSITE NAMff AND/OR POW WEEK EN ING DATE ❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? YES IF YES, NOTIFY SELECTEMP. IMMEDIATELY. NO 0 :3a Hours to nearest quarter hour.' .. CUSTOMER COPY SELEGEN .. Sunday 'EM PLO Y E N SER V -ICES P.O. Box 71250 • Eugene, OR 97401 Monday 541.746.6200 Fait 541.746.7380 PLEASE PRINT EMPLO SMAL SECURITY NUMB 1 CO ANY NAME e— EEK ENDING DATIt ❑ ASSIGNMENT COMPLETED V IRETURNING NEXT WEEK HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? YES IF YES, NOTIFY SELECTEMP IMMEDIATELY, NO Tuesday Friday Saturday Tuesday Wednesday Thursday Friday Saturday WHITE: CUSTOMER COPY SELEGEMP. Sunday EMPLOYMENT SERVICES P.O. Box 71250 • Eugene, OR 97401 Monday 541.746.6200 Fax 541.746.7380 PLEASE PRINT % EMPLO NAME SOCIAL SECURITY NUMBER J C PANY NAME WEEK END DATE ASSIGNMENT COMPLETED ❑ RETURNING NEXT WEEK HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? ❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. NO Tuesday Wednesday Thursday Friday Saturda START STOP REG:HOURS REG OVERTIME' HOURS EMPLOYEE I can fy that the hours shown represent my total home worked during the week; and that theywere property verired by the distil orby an authorized representative. Also work related Inlurlas xjare repo tl m 591eclamp r at the time of njury c; ravel rlher tit l�' X li �T)} ' 3 ;�-50 �H / OURS 76 Slgnat Employee CLIENT. We realize that to transfer me ol,Selectemp's employees to our - 'payroll requires a settlement. See reverse for further information. 1 hereby ce y that the above hours re correct X ” Signaturtt of Supervisor httLyv z a 3 mop 7.5 TOTAL TOTAL Gate. - Da ta 3 :3 3 "3 5 i I I Hours to nearest quarter hour. YELLOW: EMPLOYEE COPY TOURS HOURS, REG:HOURS O.T HOURS OVERTIME HOURS EMPLOYEE I can fy that the hours shown represent my total home worked during the week; and that theywere property verired by the distil orby an authorized representative. Also work related Inlurlas xjare repo tl m 591eclamp r at the time of njury c; ravel rlher tit l�' X li �T)} ' jam'' "(7 Slgnat Employee CLIENT. We realize that to transfer me ol,Selectemp's employees to our - 'payroll requires a settlement. See reverse for further information. 1 hereby ce y that the above hours re correct X ” Signaturtt of Supervisor httLyv z a 7, mop 5 TOTAL TOTAL Gate. - Da ta TOTAL TOTAL FOR OFFICE USE ONLY REG. HOURS O.T. HOURS EMPLOYEE I certify that the hours shown represent my total Was .*ad during Me week, and that they were properly verited by the client or by an authorized representative. Also, any work related injuries were r ported to Selectemp at the llm� Z herees for further f on 1 X ' 517 Employee CLIENT We realize that to transfer one of Selectamp's employees to our R ayroll requi res a settlement See reverse for further Information. I areby oe% that the above h rs aI correct. X S perdu al Supervisor &t�x S# Title Data HARD WHITE: SELECTEMP COPY START STOP LESS LUNCH 'PEG HOURS OVERTIME HOURS 3 3 mop 5 3'3c �3a 3 **TT •, (o o J 3 "3 5 - - TOT TOTAL Hours to nearest quarter hour. 3 J FOR OFFICE USE ONLY REG. HOURS O.T HOURS EMPLOYEE I certify that the hours shown represent my total hours worked during the week, and Met they were proper: eeribed by the client or by an authozed representalNS. Also, any work related Injuries were reported to Selectemp at limo. Injury. See averse for further info ab.I 0 X nat IEm CLIENT We realize that to transfer one of Selectemp's employees to our payrolt requires a settlement. Sae re ates for further information. I ereby certlly that the above q ho mare correct. ( � i mil! __ ;; I ,, SSup son {SL2tk JPt. Title J Dale ' u,uiTC. r.1. tins. —.1 — I nub cnlcp nvvv Int'v Ha An INH ITP FFI PCTFfdP r.nPV