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AU IMP <br />STOP <br />EMPL0YMEMT <br />SERVI(ES . <br />P.O. Box 71250 • Eugene, OR 97401 <br />PLEASE PRINT <br />.LUNCH I 'HOURS HOURS qEG HO <br />Sunday <br />Monday <br />Tuesday <br />_ EMPLOYEE NAME <br />/ spoi S C ITY NUMBER <br />lL 7 <br />QOMPANY.NAME <br />. _ <br />WEEK EN ING DATE <br />El ASSIGNMENT COMPLETED (❑r RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />El YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />SELEGEMP <br />E M P L'6 Y E N T S:FRA F(: E'S <br />P.O. Box 71250 • Eugene, OR 97401 <br />of CARP PRINT <br />START <br />Sunday <br />z <br />Monday, <br />r <br />r <br />�Tuesaey <br />EMPLOYEE NAME <br />SOCIAL SECURITY NUMBER <br />.. '.COMPAtyY NAME .. <br />WEEK ENDING DAT <br />[I ASSIGNMENT COMPLETED [P�RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK ?' <br />❑�YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />44 7 NO <br />Wednesday <br />Thursday' <br />Friday <br />Saturday <br />LV U <br />STOP <br />LESS <br />LUNCH <br />'I REG <br />HOURS. <br />OVERTIME <br />HOURS, <br />�� <br />.iC <br />l 11U <br />3$ <br />; 30 <br />f. <br />a <br />;oa <br />�3b <br />l <br />'50 <br />y1 <br />fN <br />7D <br />l� <br />URS O.T.HOURS <br />E '- EMPLOYEE: <br />I ashly that the hours shown represent my total hours worked during ere <br />week, and that truly were properly warned by the client or by an autlwrizad <br />u preeentetive. Also, any work minted! Injuries were reported to Selectemp <br />at the time of Injury. See reveree for turner Information. <br />" SIg�Vwa mplviea <br />CLIENT <br />We realize that to transfer one of Salecfemp's employees to our <br />R ayroll requir s a settlement. Sae reverse for further information. I <br />ereby c If he abare If urs ar correct. <br />X A -- ,- <br />S gna\ re of Satosh m <br />' TOTAL TOTAL <br />Hours to nearest quarter hour. <br />_ . he 6 Data <br />.. - CUSTOMER COPY -- <br />Thursday, <br />Friday <br />Saturday <br />SELECTEMP 1 Sunday <br />EMPL0YME NT SE RVI(E i <br />P.O., BOX 71250 • Eugene, OR 97401 Monday <br />PLEASE PRINT <br />/ EMP <br />11 <br />SF NUMBER <br />/1 Y COM } NY NAME <br />C Tl t` 2 '— 1 <br />JOBSITE -NAME AN Di PO# <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED 'CJRETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK ?. <br />rE ❑y,YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />Wednesday <br />Thumbs <br />Floo <br />Saturda <br />r' ✓ <br />•gyp 17 �? <br />r� <br />5 <br />zC <br />Hours to nearest quarter hour. <br />CUSTOMER COPY <br />START <br />STOP <br />LESS <br />LUNCH <br />'I REG <br />HOURS. <br />OVERTIME <br />HOURS, <br />l 11U <br />3: oa <br />"20 <br />f. <br />l <br />'50 <br />y1 <br />fN <br />7D <br />l� <br />'Hours to nearest quarter hour. <br />CI IRTnMFR COPY <br />O.T. HOURS <br />EMPLOYEE <br />I certify that the hours shown represent my total hpurs milked during the <br />week and that they were property verified by the lent or by an authorized <br />representativic. Also any work reletetl injuries were reported to Salectemp <br />at the h in eo injury . See e+' reverse tortydh rofo ton.' <br />J am ' / � <br />Signeluy'of Employae <br />CLIENT <br />We realize that to transfer one of Selectemps employees to our <br />payroll regyires a settlement. See reverse for further information. I <br />hereby ca dy [ hatthe abo/v /e,., o��ursy /i re correct. <br />X , <br />�I if 1'\ <br />Signa lure of Supervisor <br />1 <br />- 4 p Dale <br />