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ALK!tMR <br />- <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 a Eugene, OR 97401 <br />PLEASF P RINT <br />EMPLOYEE NAME <br />�cAC� i'o5tt1� <br />CAL SECURITY NUMBER. <br />G >JJJ> COMPANY NAME <br />(:) ' eE1C- <br />JOSSITE NAME AND/OR POp <br />Li 2-'lT EOE ENDING DATE <br />❑ <br />ASSIGNMENT COMPLETED I�RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />p YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />/ NO <br />,CUSTOMER COPY - <br />SE L E (TEMP. Sunday <br />EMP L0YMENT 5ERYI(ES <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />541.746.6200 Fax 541.746.7380 <br />6IUP _:I LUNCH I.HOURS <br />3 -'oo 3o i T5, <br />3:(6 3 ,fh i 74 <br />330 Mi r n/ <br />30 <br />Hours to nearest quarter hour. <br />PLEASE PRINT <br />5 <br />EMPLOYEE NAME <br />t Pa' It <br />SOCIAL SECURITY NUMBER <br />_38 5 <br />COMPANY NAME <br />CG k CA- em ewe <br />WEEK ENDING DATE <br />' 51� 13.n 9 <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ONTHE JOB INJURYTHIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />F y.•Al0 <br />Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />'!Friday r0p <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />WHITE: CUSTOMER COPY <br />S ELEGEMP. <br />EMPLOYMENT SE RVI(ES <br />P.O. Box 71250 • Eugene, OR 97401 <br />541.746.6200 Fax 541.746.7380 <br />PLEASE PRIN <br />F EMPLOYEE NAME <br />SOCIAL SECURITY NUMBER <br />COMPANY NAME <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED EVETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB 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 />OVERTIME <br />HOURS <br />Tco <br />3:% <br />3u; <br />77, <br />��2 ( 19 <br />Tccs <br />3`c <br />36, <br />7P?, <br />TOO <br />3'•00 <br />300 <br />- 7 41 <br />Hours to nearest quarter hour. <br />YELLOW: EMPLOYEE COPY <br />FOR OFFICE USE ONLY <br />REG.HOURS O.T. HOURS <br />EMPLOYEE <br />I Canty that the hours shown represent my total hours worked during the <br />were week, and that they we properly verified M the Client or by an authorized <br />represeneuvw. Alan, any work related Injuries were reported to Selsdarep <br />at the time of injury. See reverse for further information. <br />X A, J P }� <br />EMPLOYEE <br />I certify that the haute shown represent my total hours worked during the <br />week, and Net they were properly verified try the client or by an authorized <br />repreeental Also, any work related injuries were reported to Selectemp <br />at the time of Injury See reverse for further information. -- <br />x <br />Sgnature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires settlement See reverse for further Information, I <br />• herebycenl th itheabovehoumarecorrect <br />I <br />X ( _ <br />S gnatu a of Supervisor <br />rAL' to <br />Title Delp <br />TOTA LJ, J <br />3 <br />Signature 0 Employee <br />HOURS <br />CLIENT <br />We realize that to transfer one of Smectemp's employees to our <br />p ayroll requires a settlement. See reverse for further information. I <br />h erebycertl thattheadove our ere corren. <br />X I:t <br />Sartitur aSupevisor <br />KLAA !&x 3 —S -1 n, <br />Title Date <br />HARD WHITE: SELECTEMP COPY <br />Hours to nearest quarter hour. <br />1 V INl <br />FOR OFFICE USE O NLY <br />7 RS O.T.HOURS <br />EMPLOYEE <br />I Carl that the hours shown represent my total hours warked during the <br />week, and Nat they were properly wedged by the diem or by an authorized <br />repreembeive. Also, any work related injures were reported to Selectemp <br />at the time al Injury. See reverse for further information. <br />X oti ?P UL <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires a settlement. See reverse lot further information. I <br />hereby cei that the allows hours are correct. <br />Signatu s of Supervisor <br />f IZ /O <br />T Date <br />111"1 11 m,-n'eFa rii VPI I M PMPI OYFE COPY HARD WHITE: SELECTEMP COPY <br />TOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />jo <br />:oo <br />'7z <br />��2 ( 19 <br />1'S <br />Hours to nearest quarter hour. <br />1 V INl <br />FOR OFFICE USE O NLY <br />7 RS O.T.HOURS <br />EMPLOYEE <br />I Carl that the hours shown represent my total hours warked during the <br />week, and Nat they were properly wedged by the diem or by an authorized <br />repreembeive. Also, any work related injures were reported to Selectemp <br />at the time al Injury. See reverse for further information. <br />X oti ?P UL <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires a settlement. See reverse lot further information. I <br />hereby cei that the allows hours are correct. <br />Signatu s of Supervisor <br />f IZ /O <br />T Date <br />111"1 11 m,-n'eFa rii VPI I M PMPI OYFE COPY HARD WHITE: SELECTEMP COPY <br />