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ILE(TEMP <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />DI CACC DQIN'T <br />_ <br />EMPLOYEE NAME i <br />SOCIAL SECORMNUMBER <br />�COMPA Y NAME <br />Et e-ne., . <br />JOBSIT AME ,ND/OR POII <br />1 C� C <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 />,* Sunday <br />Monday <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 />J .. <br />00 <br />r <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 war& properly verified by the client or by an authorized <br />representative. Also,'any work related injuries were reported to Selectemp <br />at the t Le'of i njury. See reverse for further i fop rmation. . <br />X/ <br />Signaturd <br />Q Employee - <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 />hereb i that the abovehours are correct. <br />ature of Supervisory <br />TOTAL' " TOTAL - <br />Hours to nearest quarter hour: , <br />Title Date <br />CUSTOMER COPY. <br />