New Search
; �.m. <br />SE�LE(T.EMP: <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />or �ec� oor�rr <br />EMPLO ENA <br />I l,� <br />CIAL SECURITY NUM R <br />t <br />4 COMPANY NAME <br />t vi ,C vtA- -. <br />JOBSITE NAME A D /OR. PO# <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED +1 RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY.. <br />NO <br />Aunday <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 />r t <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 were properly verified by the client or by an authorized <br />representative. Also, any work related injuries were reported to.Selectemp <br />at the tire jury. See reverse for further i (Srmation. <br />X C�✓ t�- <br />Signature of Employee - <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requir s a settlement. See reverse for further information. I .. <br />he thatours are correct. <br />X <br />gnature off S / uper er— <br />' TOTAL TOTAL <br />Hours to nearest quarter hour. Z3. e <br />Title Date <br />CUSTOMER. COPY <br />