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f� <br />R L.1 k I C I V SuntleY <br />'" EMPt0'YMENT SERY I,('Ef <br />P.O. BOX 71250 • Eugene, OR 97401, Manday <br />PLEASEPRINT ';Tuesday. <br />'EMPLOYEE NAIL <br />SOCIAL SE 'COAITV: NUMBER <br />COMPANY NAME <br />s WEEK ENDING DATE <br />El t <br />ASSIGNMENT COMPLETED Q'RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY T41S WEEK? <br />YES IF YES, NOTIFY SELECTEMR IMMEDIATELY. <br />(� NO <br />orked during the <br />by im authorized <br />etl to Selapemp: , <br />SLECTMP Sunday <br />E -MIf L0YMENT S RYLCES <br />P.O. Box 71250 • Eugene, OR 97401 Monday. <br />PLEASE PRINT. <br />PLOYEE NAME <br />cl��hoL {z- <br />SOCIAL SECU jLTV NUMBER <br />OMPAjjN""Y NAME <br />pp <br />✓ JOBSITE NAME AND /OR PO# <br />W,EK ENDING DATE <br />ASSIGNMENT COMPLETED .❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />.Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />STOP <br />payroll regmres'e aaftk <br />;hhereby ce6fy that the a <br />REG <br />HOURS <br />W9 his, <br />SignaW h1ft. rvisar <br />I <br />Thurs day <br />TOTAL <br />, <br />' <br />JJ <br />•: <br />'Friday <br />5 <br />Saturday <br />�6 <br />st. <br />Q <br />` <br />Hours <br />Hours to nearest quarter hour <br />orked during the <br />by im authorized <br />etl to Selapemp: , <br />SLECTMP Sunday <br />E -MIf L0YMENT S RYLCES <br />P.O. Box 71250 • Eugene, OR 97401 Monday. <br />PLEASE PRINT. <br />PLOYEE NAME <br />cl��hoL {z- <br />SOCIAL SECU jLTV NUMBER <br />OMPAjjN""Y NAME <br />pp <br />✓ JOBSITE NAME AND /OR PO# <br />W,EK ENDING DATE <br />ASSIGNMENT COMPLETED .❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />.Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />CUSTOMER COPY " <br />START' <br />STOP <br />payroll regmres'e aaftk <br />;hhereby ce6fy that the a <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />SignaW h1ft. rvisar <br />TOTALLL� <br />TOTAL <br />CUSTOMER COPY " <br />START' <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />T 10 <br />�6 <br />Q <br />u <br />FOR OFFICE USE ONLY <br />REG HOURS'" ' O.T HOUR5. ' <br />EMPLOYEE <br />I certly that the ho rs shown represent my total hours worked dunng the <br />week and tM1at they we p party veriftetl byth d entorbyaneuthtnzed <br />repress t anywok latatl nlur rs erg reported to Seiaetemp <br />flM1et me of ln'ury See raver rvtu r to on. <br />Signature of E41oyee LJ - <br />CLIENT. <br />We roalize that to transfer one of Selectemp5 employees to our <br />payroll requl sa settlement. S a for further Information. I <br />It certit hat the ab hYr�POr - ct. <br />Tit i7� Zatl�—�� '. <br />2Z TOTAL <br />Nouns to nearest quarter hour ,'J�r' <br />