New Search
S.ELE(TEMP <br />EMPLOYMENT SERVICES <br />P.O. Bm 71250 Eugene, OR 97401 <br />DI FACE DRINT <br />A <br />�unday <br />Monday <br />EMPt NAME <br />CIAL SECURITY NUMBE <br />OMPANY NAME <br />© <br />JOBSITE NAME AND/ • PO# <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED XRETURNING 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 />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />` <br />.wl <br />(� <br />Z; <br />(� <br />,-- <br />30 <br />7S <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 the time of injury. See reverse for f + er information. ' <br />X to 1�. H ✓. <br />Signature of Employee <br />CLIENT` <br />We realize that to transfer one of Selectemp's employees to our <br />payroll req res.a settlement. See reverse for further information. I . <br />hereb fy that the abov urs are correct. <br />Si ure of�S�uP viso <br />C <br />TOTAL TOTAL. ly) I7 — 1/ <br />hour. <br />Hours to neatest quart er <br />Title Date <br />CUSTOMER COPY <br />