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Bu �� I EP ■ P L e5 EMPLOYMENT SERV I.(ES P.O. Box 71250 • Eugene, OR 97401 vwr b EMPLOYEE NAME ✓� d f o 1r le -a < ` SOCIAL SECURITY NUMBER C NAME JOBSITE NAME AND /OR POW WEEK ENDING DATE )0 - ❑ASSIGNMENTCOMPLETED C RETURNING NEXT WEEK HAVE YOU HAD ANON THE JOB INJURY THIS W EEK ?" ❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY, NO CUSTOMER COPY SELE GEMP. Sunday EMPLOYMENT SEAYI(E5 P.O. Box 71250 • Eugene, OR 97401 Monday 541.746.6200 Fax 541.746.7380 PI FARF PRINT EMM n PLOYEE NAME i '0 t' SO IAL SECURITY NUMBER 3ff 5 a COMPANY NAME C. o EL ge ne, WEEK ENDING DATE 2-11311 ASSIGNMENT COMPLETED MRETURNING NEXT WEEK HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? ❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. C^O Tuesday Wednesday Thursday Friday Saturday z FOR OFFICE USE ONLY REG. HOURS O.T. HOURS EMPLOYEE I certify that the hours shown represent my total boors worked during the week, and that they were properly venfied by the client or by an authorized representative. Also any work related injuries were reported to Seleclemp at the time of injury . See reverse for further information. X . A ,A a 5-kf- Signature of Employee CLIENT We realize that to transfer one of Selectemp's employees to our R ayrell requires a settlement. Sae reverse for further Information. I ereby cert at the above h ors a correct. X n_ �1� -�--_ Signaldral Superviso( TOTAL TOTAL Hours to nearest quarter hour. '3v Tile Due START START - STOP LUNCH. HOURS I "HOURS. - 'REG:HOURS O:T HOURS V( t1! Sunday 76 3 :00 I %. 7. 7 ,•00 Monday � ��) �(�, f � /A5 3 - oo '�l Tuesday 'ednesdaY 1 certify that the hours mown EMPLOYEE represent mylot21 hours worked during fie week and that they were properly yertlletl lty the ckem or by an authorized ep hi Also any work related lf es were reported to Seleclemp at the ( Ind of mlury, Sea re for further dformation. X I_)4 C" A - 17CJ J ttl� 7l �4 , nv. 3rv.,/ v 7 q ( / _ 1 '' /'(/(� f / Q (f: Ark Thursday _ r o ^ � V ' 7 T 5 Signature of Employee. .- " CLIENT Frida Y ', / ) �^ � We realize that t6 transfer one of Selectemp's employees to our payroll requires a settlement. See reverse: for further Information. I republic 11 that the above�hoors�ra correct. Saturday X G'^'s"""- Sgnat eof Supervisor Hours to nearest quarter hour. ( j / / } �/� � I Irll. �Y— oa ^2u,u 'T(OTPAL 3Fh,(f' TOTAL � tle b EMPLOYEE NAME ✓� d f o 1r le -a < ` SOCIAL SECURITY NUMBER C NAME JOBSITE NAME AND /OR POW WEEK ENDING DATE )0 - ❑ASSIGNMENTCOMPLETED C RETURNING NEXT WEEK HAVE YOU HAD ANON THE JOB INJURY THIS W EEK ?" ❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY, NO CUSTOMER COPY SELE GEMP. Sunday EMPLOYMENT SEAYI(E5 P.O. Box 71250 • Eugene, OR 97401 Monday 541.746.6200 Fax 541.746.7380 PI FARF PRINT EMM n PLOYEE NAME i '0 t' SO IAL SECURITY NUMBER 3ff 5 a COMPANY NAME C. o EL ge ne, WEEK ENDING DATE 2-11311 ASSIGNMENT COMPLETED MRETURNING NEXT WEEK HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? ❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. C^O Tuesday Wednesday Thursday Friday Saturday z FOR OFFICE USE ONLY REG. HOURS O.T. HOURS EMPLOYEE I certify that the hours shown represent my total boors worked during the week, and that they were properly venfied by the client or by an authorized representative. Also any work related injuries were reported to Seleclemp at the time of injury . See reverse for further information. X . A ,A a 5-kf- Signature of Employee CLIENT We realize that to transfer one of Selectemp's employees to our R ayrell requires a settlement. Sae reverse for further Information. I ereby cert at the above h ors a correct. X n_ �1� -�--_ Signaldral Superviso( TOTAL TOTAL Hours to nearest quarter hour. '3v Tile Due START STOP LESS LUNCH REO HOURS OVERTIME HOURS V( t1! 76 3 :00 I %. 7. 7 ,•00 3'3U '7 00 3 - oo '�l T5 i1 3roo 1/) 7.5 WHITE: CUSTOMER COPY SELE P� Sunday EMPLOYMENT SE RVI(ES P.O. Box 71250 • Eugene, OR 97401 Monday 541..746.6200 Fax 541.746.7380 PLEA PRINT EMPLOYEE NAME SOCIAL SECURITY NUMBER 385 COMPANY NAME L, o F- C s Cli z WEEK EN ING DATE � j0 ❑ ASSIGNMENT COMPLETED VRETURNING NEXT WEEK HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? LJ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY, NO Tuesday Wednesday Thursday Friday Saturday YELLOW: EMPLOYEE COPY FUR UFMGH U51; V1V LT 77 O.T HOURS EMPLOYEE I certify that the hours sham represent my total hours worked during the weak. and Thal they were p.,all, verified by the dlent or by an aWner ead representative. Also, any work related injuries were reported to Seleclemp at the time of injury. See twitter, for further information. x� .:>mpl Q�yt uL Sgnet 4 of Employee CLIENT We realize that to transfer one of Selectemp's employees to our payroll requires a settlement. See reverse for fulaher Information. I erehy .:n that the abo hour era correct. X n( ��.; Similar of Supervisor TOTAL TOTAL ' Th (n Myy - _�'J Hours to nearest quarter hour. Ti l \ Ie LLNrt " t{i D_al V HARD WHITE: SELECTEMP COPY START STOP LESS LUNCH I AEG HOURS OVERTIME HOURS V( t1! 70,0 3 - oo 3o 7.5 7• -aV 3:od 3® 7- S WHITP Ct ICTnMFR COPY YELLOW: EMPLOYEE COPY HARD WHITE: SELECTEMP COPY