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' Lt` ,. Sunday <br />E M P L O Y M E N T S E R V I( - .E S <br />P.O. Box 71250 • Eugene, OR 97401- Monday <br />V <br />LESS <br />LUNCH <br />LUNCH <br />I HOURS! <br />HuUHS <br />"REG. HOURS' - OT HOURSc Cr <br />Wednesday <br />JOBSITE NAME A�NDi PO# <br />WEEK ENDING DATE <br />.} <br />3. <br />�'' <br />EMPLOYEE <br />/ES IF YES, NOTIFY SELECTEMP IMMEDIATELY <br />' NO <br />. <br />PLEASE PRINT <br />I T1 EMPLOYEE NAM <br />SOCIAL SECURITY NUMBER <br />n COMPANY NAME <br />UI�.f UT r�LnR' <br />- WEEK ENDING DATE <br />1� ?'1617 <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK' <br />HAVE YOU HAD ANON THE JOB INJURY. THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />Q NO <br />Tuesday <br />_ <br />' <br />� ' <br />, Ji <br />LESS <br />LUNCH <br />l.0 <br />-, <br />/ <br />1 <br />Rf3g <br />` I Cali th the hours h' . n repreeant my �l �fbura worked during the <br />va6k end of May were properly vetllletlb h diem or. by an euthatlxe0 <br />represent 11 Also any work relffietllnlu, w�r4 reported 0 Selectemp <br />' et the llmJ hinjury. See reverse for further 171017llon <br />Wednesday <br />JOBSITE NAME A�NDi PO# <br />WEEK ENDING DATE <br />.} <br />3. <br />�'' <br />HAVE YOU HAD AN ON THE JOB INJURY.THIS WEEK?' <br />/ES IF YES, NOTIFY SELECTEMP IMMEDIATELY <br />' NO <br />. <br />- <br />.. Signatur�a Empoye� " i <br />Thursday <br />I .;O <br />? :'00 <br />3 : <br />CLIENT <br />7 °` <br />E <br />° <br />J <br />"> <br />30 <br />Fndey <br />We realize that to transfer one of Selecternes employees to our <br />payroll requires settlement. See' reverse' for further information. I <br />hereby certify that the above hours are coned. <br />G <br />i Saturday <br />Sunday <br />E M P L 0 Y M E N T S E R V I - (:ES <br />,. , .P.O. Box 71250 • Eugene, OR 97401 - Monday <br />PLEASE PRINT <br />(� EMPLOYEE AME <br />[JfxtYlerorl. ��c✓� <br />SOCIAL SECURITY NUMBER <br />9131 <br />COMPANY NAME <br />JOBSITE NA E AND /OR PO# <br />r � WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED ASSIGNMENT COMPLETED RETURNING NEXTWEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />El YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />C�? NO <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />TOTAL: TOTAL <br />Hours to nearest quarter. hour <br />CUSTOMER :COPY - <br />START <br />STOP <br />LESS <br />LUNCH <br />AEG ". <br />HOURS <br />OVERTIME <br />HOURS <br />1 <br />Rf3g <br />C MPANY NAME <br />,(( <br />?N <br />(C n,7/ ";Me- <br />JOBSITE NAME A�NDi PO# <br />WEEK ENDING DATE <br />Zx,13 M <br />,a,//,� <br />El PLETED O ASSIGNMENT COMRETURNING. NEXTWEEK <br />HAVE YOU HAD AN ON THE JOB INJURY.THIS WEEK?' <br />/ES IF YES, NOTIFY SELECTEMP IMMEDIATELY <br />' NO <br />"TOO <br />7 *00 <br />3:30 <br />.3o <br />? :'00 <br />3 : <br />30 <br />7, s <br />7." <br />3, <br />30 <br />7. ; " <br />S `bfSupeen <br />Title, <br />FOR OFFICE USE ONLY <br />REG.HOUR S 2 'O.THOURS - <br />EMPLOYEE <br />I ci t t the hours shown represent my local hours wo ked during the <br />weeks the hours veri9ed tryh dent orbya aulhorized <br />repmse two. Ms., any work related I e e reported to Selectemp <br />edhe ll a <br />of i njury. See reverse for furl mflOpn. <br />Signatr6B of Employee <br />CLIENT. <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires a settlement. Sea reverse for further information. 1 <br />herebycertl thattheabov o aarocoi <br />x, t1�� <br />Signaturk of Supervisor <br />OTAL TOTAL 1 <br />Hours to nearest quarter hour' !_II�j () J Z ~ - Z�f <br />Tine Date <br />• Vyyyp»' <br />CUSTOMER CORY <br />E`.M P L0 Y E NT SE NV ICES <br />P.O. Bw 71250 • .Eugene, OR 97401 ` <br />PI FACF PRINT <br />Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />START <br />EMPLOYEE NAME <br />LESS <br />LUNCH.. <br />Arne.(' Yy At-m; <br />SOCIAL SECURITY NUMBER <br />1 <br />Rf3g <br />C MPANY NAME <br />,(( <br />?N <br />(C n,7/ ";Me- <br />JOBSITE NAME A�NDi PO# <br />WEEK ENDING DATE <br />Zx,13 M <br />,a,//,� <br />El PLETED O ASSIGNMENT COMRETURNING. NEXTWEEK <br />HAVE YOU HAD AN ON THE JOB INJURY.THIS WEEK?' <br />/ES 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 />o <br />"TOO <br />7 *00 <br />3:30 <br />.3o <br />7;00 <br />3;00 <br />go <br />1 <br />Tj':04 <br />-3 . Or` <br />33 <br />7;5 <br />Hours to nearest quarter hour. <br />'AEG: HOURS - O.T. HOURS <br />EMPLOYEE <br />cad fy a oiM1e hou s shown represent my local hours worked d g the <br />weeks at hey were p operlyYwIed by th Bent or oY an arnhodzed <br />r p se <br />at e: Aso, any work related ry es a repoded to Selearmi <br />at M t friary See perm se f. rah tlon. <br />x a"Mi-' <br />Signature of Employee <br />