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` ) LK I LM Sunday '5TAF <br />r <br />E MPL0YME NT 5 RV E(ES <br />RO. Box 71250 • Eugene, OR 97401 „ Monday <br />PLEASE. PRINT <br />.EMPLOYEE NAME Tuesday <br />SOC t I,QL <br />ITY NUMBER <br />C MPANY NAME <br />C,i ,,T G " <br />_ BSITE N <br />ME AND/OR PO# <br />EK EN ING DATE <br />- L-- - L -T <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />in NO <br />Thursday <br />Friday <br />Saturday <br />SELEGEMp Suaday <br />E 1IPL0YMENT SERVICES -` <br />P.O. Box 71250 • Eugene, OR 97401.. Moggay <br />PLEASE PRINT <br />EMPLOYEE NAME , <br />SOCIAL SECURITY NUMBER <br />�OMPANY NAME <br />'Y ..f` p;C <br />JOBSITE NAME AND /OR PO# <br />WEEIK ENDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXTWEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />DIY ES IF YES; NOTIFY SELECTEMP IMMEDIATELY. <br />U NO <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />5 <br />J <br />ly . <br />TgK TOTAL <br />Hours to nearest quarter hour. <br />START <br />STOP <br />'LESS <br />LUNCH - <br />REG:' <br />HOURS <br />OVERTIME. <br />HOURS <br />j <br />Su <br />5 <br />V <br />J <br />1 <br />3 G <br />1.5. <br />1 <br />3 <br />0U <br />�r <br />TOTAI-r TOTAL <br />Hours to nearest quarter hour, <br />COPY <br />T,- <br />S <br />EMPLOYMENT SE RVI(ES <br />P.O. Box 71250 • Eugene, OR 97401 <br />nt PAQP coINIT. <br />J EMPLOYEE NAME <br />SOCIAL SEAORITY NUMBER <br />U, <br />f � <br />COMPANY NAME <br />JOBSITE NAME ANd %OR PO# <br />EE( ENDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXTWEEK <br />HAVE YOU HAD AN ONTHEJOB INJURY -THIS WEEK? <br />YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />GVERTIME <br />HOURS.. <br />j <br />Su <br />5 <br />�3( <br />5,5 <br />1 <br />3 <br />0U <br />�r <br />- REG. HOURS `. OT HOURS <br />EMPLOYEE <br />I card, that the hours M1 .,..am my total hours worked during Ina <br />week and that they were properly ver by the client or by an authorized <br />representatives Alm any work related Injuries were reported to Selemarep <br />el the tlm al injury se revers br Iu Ner nlmmatim. <br />X 17 o <br />SignetuFe ofErp loyee <br />>EMPLOYEE� <br />I daffy that no hours shown represent my total hours worked during the <br />weak antl Mat they ware properly ♦e I tl by the cl ont or by an a thorized <br />representative: Also any work related injur were reported to Selectemp <br />at the t inluy So.,eve� ICr fu Ina fo on. <br />Sig nations o1 <br />'. r FOR OFFICE USE ON <br />REG. HOURS' - 07 HOURS <br />EMPLOYEE <br />I certify, that the hours shown represent my total hours worked during the <br />week and that they were properly werhad by the client or by an authorized <br />representative, Also any work related injuries were reported to Salectemp <br />at the t f ntury See me for W they lem ation. <br />atV <br />Signature ok' mplood <br />CLIENT <br />We realize that to transfer one at'Setectsmp's employees to our <br />payroll requires ,a settlement. See reverse for further mtormi I <br />hereby certit that the above hours are correct. <br />f <br />X n <br />Signal of Supervisor <br />' I V IN I� �lM S ,Z I. <br />Hours to nearest quarter hour. Z Tine Dole <br />CUSTOMER COPY <br />q <br />yP <br />