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A L I <br />TOO <br />EMPLOYMENT <br />SERVICES <br />P.O. Box 71250 m Eugene, OR 97401 <br />GI FAQ9 PRINT <br />EMPLOYEE E <br />Of ri, <br />SOCIAL SECURITY NUMBER <br />943` <br />L Cf PANY NAME - <br />JOBSITE NAME AND /OR PO4 <br />WEEK ENDING DATE <br />3 13' //QQ <br />El ASSIGNMENT COMPLETED *RETURNING NEXTWEEK, <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />YES IF YES, NOTIFYSELECTEMP IMMEDIATELY. <br />NO <br />)URS HOURS TiEG H0UR5 OTHOURS <br />Monday <br />TOO <br />100 <br />REG <br />HOURS. <br />+ •� <br />.;_EMPLOYE 'e .. <br />:r.'.. <br />t• 40 <br />It" <br />�;«� <br />7 <br />Tuesday, <br />�71�r 1 <br />+ V <br />;o0 <br />,3U <br />715-- <br />1 I a the shown represent t . worFetl during the <br />week a at they were properly winl y client or by an authorized <br />Wednesday <br />reptese et Also any work related n ere reported to Selectemp <br />at then a of Injury. See reverse for fur ma tron:. <br />.. <br />-7,6 <br />3,30 <br />3d <br />6 <br />30 <br />7:5 <br />7 :00 <br />3;00 <br />.3o <br />7.5 <br />6 gna <br />Thursday 7. du <br />3.tlQ 30 <br />/' <br />7 ,} "' <br />a of E playas <br />CLIENT <br />Friday <br />Y• QUJ <br />Q <br />3 4(l <br />O <br />7- S <br />- We real ze that 1. transfer one of Selectem'p s. employees r <br />See <br />payroll require a settlement. reverse for further information. 1 <br />hereby cerlHy�yyn)il the aboe /h(o`u,rs are rtat <br />Saturday <br />Signatur al Superviso <br />TOTAL TOTAL;,, <br />3 8 <br />3 .Date� z W, <br />Round to nearest quarter hour <br />.. <br />Title " <br />CUSTOMERCOPY <br />-.. . . <br />SELECTS P Sunday <br />Isiss <br />EMPLOYMENT SERVII <br />'P.O. Box 71250 • Eugene, OR 97401 Monday <br />PLEASE PRINT <br />'EMPLOYEE NAME <br />SOCIAL SECURITY NUMBER <br />C CC COMPANY NAME <br />_,,A Q&al,_jj NAME AND / OR PO44 <br />nnW^^EEK ENDING DATE <br />lid ASSIGNMENT COMPLETED ❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ONTHE JOB INJURYTHIS WEEK? <br />❑YES IF YES, - NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />START <br />STOP <br />TIE 58 <br />LUNCH <br />REG <br />HOURS. <br />OVERnME <br />HOURS <br />t• 40 <br />It" <br />�;«� <br />.30 <br />7,00 <br />;o0 <br />30 <br />715-- <br />7:00 <br />3:30 <br />30 <br />TO <br />3;00 <br />30 <br />7:5 <br />7 :00 <br />3;00 <br />.3o <br />7.5 <br />..BEG HOURS.' O.T. HOURS <br />EMPLOYEE <br />I cattily I the hours shown represent ro 6 ours wnrketl during the <br />week, an at Ney:were properly vedl d yl rent or by an auModzed <br />:' represent e: Also any work related In reported to Selebtemp <br />a the Om al injury See reverse br WriM1 ti �n. <br />Signature of Employ6e , <br />CLIENT' <br />We realize at to transfer one of Selectemp's employees to our <br />r ymll req ee a settlement See reverse for further information. I <br />reby ce i .that the abgve�urs re wrrp ed. <br />x G `V� <br />Mount.,. of Supery $.r <br />.. - TOTAL TOTAL 4P�, • J WJ I1u:� �. 1 F e 1'' o <br />Hours to nearest quarter hour. 8L Tile Data <br />r <br />CUSTOMER COPY <br />