New Search
S ELM P <br />,STOP <br />- LESS <br />-LUNCH <br />Sunday <br />E MIt L0YME NT SERVICES <br />` <br />R0. Box 71250,•- Eugene, OR 97401 <br />Monday <br />PLEASE PRINT <br />Tuesday <br />iirrJJ /` .EMPLOYEE NAME <br />SOCIAL SEQU RITY NUMBER' <br />COMPANY NAME <br />OBSITE NAMEIAND /OR PO# <br />-WEEK ENDING DATE <br />Y ASSIGNMENT COMPLETED ❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURYTHIS WEEK? <br />2/ LS IF YES, NOTIFY SELECTEMP IMMEDIATELY <br />NO <br />CUSTOMER COPY <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />START <br />,STOP <br />- LESS <br />-LUNCH <br />REG'i <br />HOURS <br />OVEWIME <br />HOURS <br />FOR OFFICE USE ONLY <br />'REG.HOURS <br />OT HOURS <br />EMPLOYEE <br />I certify That the hours shown represent my total hours waned during fie <br />week, and that they were properly ver by the client or by an authorized <br />representative. Also any work related Intones were repuned to Selectemp <br />at the are flNur Seere ss for fu the nfarmetion. <br />g nel eol pleyee <br />CLIENT <br />We realize that to transfer one of Selecte rip's employees to our <br />= paymll requires a settlement. Sae reverse for further Information. I <br />hhereby rtify that the abw hours are correct. <br />X A 1,x. '1L� "31 <br />Sig Ihetur el9'Ifperwsor - r <br />Hours to Dearest quarter hour. �'lYl!.Cry . Ltle`P. <br />