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• �.� B O / � � � r <br />L E L L $ / \V <br />EMPLOYMENT S E RV I G:ES. <br />P.O. Box 71250 • Eugene, OR 97401 <br />PLEASE PRINT <br />Sunday <br />Monday <br />START <br />STOP <br />N. <br />LU CH <br />HOURS <br />HOURS <br />FOR OFFICE USE ONLY <br />' - <br />REGrHOURS <br />OTHOURS <br />7 <br />�.�> <br />• ;, <br />REG <br />OVERTIME <br />EMPLOYEE <br />S E LEG EM P <br />START <br />STOP <br />LUNCH <br />EMPLOYEE NAME <br />(e C: xkrx t- <br />SO IAL SECURITY NIUMBER <br />COMPANY NAME <br />, <br />'I OF (.Ju ne- <br />JOBSITE NAME AND /OR-PO# <br />WEEKE DMO DATE <br />2010 <br />❑ ASSIGNMENT COMPLETED XRETURNING NEXT WEEK <br />HAVE YOU HAD'AN ON THE JOD INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />M NO <br />Tuesday <br />Wednesday <br />�, 1 M ! <br />tj`� <br />` <br />4 � <br />- AEG - <br />HOURS <br />1 certify mal the hours shown represent my total hours worked during the <br />weak, "that they were properly verified by me client or by an authorized <br />represent five. Also any work raged es were reporleb to Seleaemp <br />at Chet e of inl g•Se erselorturther Intermation., <br />FOR OFFICE USE ONLY <br />2 <br />O.T. HOURS <br />LESS <br />REG <br />OVERTIME <br />FOR OFFICE USE ONLY <br />S E LEG EM P <br />START <br />STOP <br />LUNCH <br />cam•` <br />HOURS <br />1 <br />O HOURS <br />.lA <br />" <br />Thursday+. <br />/ <br />i1 <br />• Fntla Y <br />Y <br />S ;./r. o Em�e <br />/ <br />Sunday <br />_ <br />i <br />C IENT <br />herab Y cerh trait above re or correct <br />Saturday <br />r <br />Monday <br />(Vii realize that to transfer ode of Selectemp'a employees to our <br />.payroll requires a settlement. See reverse for furthecinfomotion. t <br />Friday <br />y <br />I <br />.L� <br />) <br />hereby esquires theabove hours reconnect. <br />Hours to nearest quarter <br />. <br />hour. <br />P.O. Box 71250 • Eugene, OR 97401 •' <br />7`tt V <br />Title Data <br />t <br />'Saturday <br />_ <br />"' <br />^`""'""' <br />X �..,. <br />°•°°" <br />Sign urd o[SupaMSOr <br />TOTAL <br />TOTAL ✓ h 3 ' <br />b <br />Hours to neares t quarter <br />hour. <br />�;(� <br />ngd Date <br />CUSTOMER COPY <br />S E LE G E MP Su ntlay <br />•- EMP.L0YMENT SERVI(ES ;. <br />P.O. Box 71250 • Eugene, OR 97401 Monday. <br />.PLEASE PRINT <br />START <br />STOP <br />LESS <br />LUNCH <br />- AEG - <br />HOURS <br />OVERTIME <br />HOURS <br />FOR OFFICE USE ONLY <br />O.T. HOURS <br />LESS <br />REG <br />OVERTIME <br />FOR OFFICE USE ONLY <br />S E LEG EM P <br />START <br />STOP <br />LUNCH <br />cam•` <br />HOURS <br />1 <br />O HOURS <br />.lA <br />" <br />l <br />• `� J CLI T <br />• Fntla Y <br />EMPLOYEE. NAME <br />,ACC G yiv A,ptri <br />SOCIAL SE URITYNUMB R. <br />COMP F�Y NAME <br />C1 �. �. <br />JOBSI E NAME. AND /OR P N <br />/ WEEK E DATE <br />2, ll7 <br />❑ ASSIGNMENT COMPLETED If-RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />❑YES IF YES, NOTIFY SELECTEMP IMMEDIATELY: <br />NO <br />rr���� EMPLOYEE <br />Tuesday - .��•,) �_W •� I certify that the hours shown represent my total hours worked during the <br />weak and that they were properly venfled by the dent or by an authorized <br />representative Also any wok related mlures were reported to Seldowmen <br />at the It of lnjtiny a reefee for further information. <br />Wednesday <br />X rL <br />Slpng IE re k ployee <br />Thursday �', .) W�. � Y � y4 /! ( / r ,. <br />0, CLI T <br />1 a hze that to transfer one Selectemp's employees to our <br />Friday -! ,19- / '� pa regmres e settlement See reveree to further informatlbn. I� <br />h�A ce y Su that the above h_ our, are caned. <br />Saturday X same <br />•.c / � f _� + <br />�. � Sgnatu of pervisor <br />TOTAL TOTAL Z� I� <br />Hours to nearest quarter hour 1 f WM J <br />Title pate <br />EMPLOYEE NAME <br />SOCIAL SEC RITY'NUMBER <br />fJ� 7 <br />COM NAME <br />JOBSITE NAME AND! R POft <br />WEEK E{VDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXTWEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />[� YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />Wednesday <br />7 <br />- CUSTOMER COPY' <br />1 <br />1 certify That the hours shown represent my total hours worked during the <br />- week. and that theywere properly verified by the client or by an authorized <br />reprearr i vo. Also, any, work related injuries were reported to Seledamp <br />attha tirr linjur L74. far ferthereaformat. , <br />_ <br />LESS <br />REG <br />OVERTIME <br />FOR OFFICE USE ONLY <br />S E LEG EM P <br />START <br />STOP <br />LUNCH <br />HOURS <br />HOURS <br />REG HOURS <br />O HOURS <br />.lA <br />" <br />l <br />• `� J CLI T <br />• Fntla Y <br />y � <br />'I ' C' <br />Sunday <br />_ <br />i <br />herab Y cerh trait above re or correct <br />Saturday <br />EMP L0YMENT SERY.I CIS <br />Monday <br />1;t.0 <br />A <br />. <br />TOTAL. TOTAL <br />Sgnatu of 5lipervsor <br />e I(W Z_I l /� —r( i <br />�1 T <br />Hours to nearest quarter <br />. <br />hour. <br />P.O. Box 71250 • Eugene, OR 97401 •' <br />7`tt V <br />Title Data <br />a G <br />4 <br />PLEASE PRINT <br />EMPLOYEE <br />EMPLOYEE NAME <br />SOCIAL SEC RITY'NUMBER <br />fJ� 7 <br />COM NAME <br />JOBSITE NAME AND! R POft <br />WEEK E{VDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXTWEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />[� YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />Wednesday <br />7 <br />/ <br />1 <br />1 certify That the hours shown represent my total hours worked during the <br />- week. and that theywere properly verified by the client or by an authorized <br />reprearr i vo. Also, any, work related injuries were reported to Seledamp <br />attha tirr linjur L74. far ferthereaformat. , <br />_ <br />X t <br />Thursday <br />r�� G <br />- 1 l ��,. <br />�" <br />�'� <br />Sgre r of mployee <br />.lA <br />" <br />l <br />• `� J CLI T <br />• Fntla Y <br />y � <br />'I ' C' <br />l <br />7 <br />We,,reallze that to transfer one of Selectemp'a employees to our <br />payroll maul s a settlement. Sea reverse for further Information. I <br />' <br />i <br />herab Y cerh trait above re or correct <br />Saturday <br />- _ <br />r, <br />X ` r <br />. <br />TOTAL. TOTAL <br />Sgnatu of 5lipervsor <br />e I(W Z_I l /� —r( i <br />�1 T <br />Hours to nearest quarter <br />. <br />hour. <br />7� <br />7`tt V <br />Title Data <br />M ICTm IrA=Q j`^O V <br />