New Search
' SELE(TEMP <br />apsunda <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />Monday <br />PLEASE PRINT <br />ENDI G DATE <br />EMPLO � E NAM <br />ar�e. <br />'sb c]AL SECURITY NUMB <br />A i ( AlMPAN�NAME <br />JOBSITE NAME ANO/dA PO# <br />K <br />ENDI G DATE <br />ASSIGNMENT COMPLETED ❑ RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />rLJ NO <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 />c� <br />a:3a <br />D <br />FOR OFFICE USE ONLY <br />HOURS O.T. HOURS <br />EMPLOYEE <br />I certify that the hours shown represent my total hours worked during the <br />week, and that they were properly verified by the client or by an authorized <br />representative. Also, any work related injuries were reported to Selectemp <br />at t ° f injury. See reverse for fur the i'fiiprmat <br />i <br />��` <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires a settlement. See reverse for further information. I <br />hereby cart hat the above hours are correct. .,, - <br />X C, _ <br />Signature of Supervisor <br />L f'4 o' 2f2 C / <br />Title Date <br />TOTAL TOTAL <br />Hours to nearest quarter hour. <br />