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) UK ILMP <br />SOCIAL,SE RIITY NUMBER <br />' EMP L0YMENT <br />SERVI7 <br />P.O. Box 71250 • Eugene, OR 97401 <br />PL FASF PRINT <br />FOROFFICEUSE'O. <br />EMPLOYEE NAME <br />SOCIAL,SE RIITY NUMBER <br />t- P <br />CO 'M((1"R ANY <br />NAME <br />OVERTIME <br />HOUg3 <br />FOROFFICEUSE'O. <br />JOBSITE NAM r AND /OR PO# <br />C WEEK TDING DATE - <br />- <br />El COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />VNO <br />EMPLOYEE <br />I certify that the hours shown represent my total hours worked'dunng the <br />week, and that they were properly verified by the client or by an authmiaed <br />representative. Also any work related injuries were reported to Seecomp <br />atthi of inju See favor information. <br />X/ <br />Signature lEmployee <br />Tide Data <br />CLIENT' <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires a settlement. See reverse. for further informal f <br />hereby can at the above �� h rs correct. <br />Big,= of Supervisor ' <br />CUSTOMER COPY <br />S ELIG START <br />E $untleY <br />E If If L0YMENT SERVI(E.S <br />P.O. Box 71250 • Eugene, OR 97401 Monday, <br />PLEASE PRINT <br />EMPLOYEE NAME <br />s�7>✓C�LI' <br />STOP <br />.LESS <br />LUNCH <br />AEG' <br />HOUg3 <br />OVERTIME <br />HOUg3 <br />FOROFFICEUSE'O. <br />REG HOURS <br />0 T HOW <br />- <br />Wednesday(" <br />- 7 <br />1 <br />f} <br />cal <br />7 C�' <br />-' Thursday <br />, <br />..EMpI nvFd <br />3a <br />1l5 <br />0 <br />Friday <br />V4�L <br />EMPLOYEE NAME <br />s�7>✓C�LI' <br />SOCIAL (S�,KU(R'I�TLY.JJJUMBER. <br />I `? Y !__ <br />1}r. COMPANY p NAME <br />' JOBSITE NAM AND /OR POS# <br />U''EEK,ENDING DATE <br />� - iU <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />❑ IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />E K L0YMENT SE RVI(E'5 <br />P.O. Box 71250 • Eugene, OR 97401 <br />acc oolnlr <br />STOP ..I LUNCH:. I'' HOURS: I. - HOURS <br />Sunday <br />Monday <br />�.. <br />3 <br />- <br />1. J <br />Tuesday <br />� <br />Wednesday(" <br />-' Thursday <br />3a <br />1l5 <br />0 <br />Friday <br />Saturday <br />Tueetlay ( <br />(. ; <br />; iz t O : <br />: ( " <br />"" I, certify that the hours shown to <br />Monday <br />fr ( ,EMPLOYEE NAME <br />ffl�. L)t. Vrui( <br />SOCIAL SECURITY NUMBER <br />i . COMPANY NAME <br />JOBSITE NAME AND/OR PO% <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED IJ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />QI. `/ES IF YES, NOTIFY SELECTEMP IMMEDIATELY <br />d NO <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />;OT 15A <br />Hours to nearest quarter hour. ,,� <br />START STOP LESS REG -. OVERTIME <br />LUNCH HOURS HOURS -. <br />-� 'J "� 5 <br />TOTAL TOTAL <br />Hours to nearest quarter hour.. <br />zz <br />ad during the <br />an authorized <br />to Sidereal <br />Y. f mplbrili to our <br />further lnfermaaon. L: <br />�Z <br />EMPLOYEE <br />I certify that the hours shown represent my free) hours worked during the <br />week and that they were pmpedy vented by the them or by an authorized <br />re presentative Also any work related Injuries were reported to Seleceemp <br />at IS faI i injury . See reverse far turth.ruf.mi <br />X Y 1,l.:. '. e: <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requi g' settlement See averse for further information. I <br />hereby ce that the eb a ours re correct. <br />X <br />Signature of Supervisor <br />Data <br />TOTAL TOTAL <br />Hours to nearest quarter hour.. <br />zz <br />ad during the <br />an authorized <br />to Sidereal <br />Y. f mplbrili to our <br />further lnfermaaon. L: <br />�Z <br />EMPLOYEE <br />I certify that the hours shown represent my free) hours worked during the <br />week and that they were pmpedy vented by the them or by an authorized <br />re presentative Also any work related Injuries were reported to Seleceemp <br />at IS faI i injury . See reverse far turth.ruf.mi <br />X Y 1,l.:. '. e: <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requi g' settlement See averse for further information. I <br />hereby ce that the eb a ours re correct. <br />X <br />Signature of Supervisor <br />Data <br />