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SELE(TEMP •s:. <br />EMDL0YMEN.T SERVI(ES <br />P.O. Box 71250 • ,Eugene, OR 97401 Monday <br />-DI PAQ9 DDIKIT'. <br />EMPLO EE NAME <br />/So <br />SO IAL SECURITY NUMBER <br />COMPANY NAME <br />0 � Z <br />BSITE NAME /OR PO# <br />WEEK ENDING DATE. <br />_. <br />2- /V <br />AS COMPLETED (XRETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />EJ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />E 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 />' DO <br />, <br />Hours to nearest quarter hour. <br />FOR OFFICE USE ONLY.- . <br />G. 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 the time of injury. See reverse for further inform atio . <br />X Chi i <br />Signature of EmplQyc� <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 ify that the above hours are correct. <br />. Signature of Supepe i <br />TAL TOTAL <br />D Title - / Date <br />CUSTOMER COPY <br />