New Search
'` <br />EMDL.OYMINT 5ERVI(ES <br />P.O. B&71250 • Eugene, OR 97401 <br />DI CAQC DDIMT <br />EM OYEE NAME <br />'9 <br />OCIAL SECURITY NUMBER <br />COMPANY NAME <br />Q) JOBSITE NAME AND/OR PO# <br />A D &SGVe �� <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAV E YOU. HAD AN ON THE JOB INJURY THIS WEEK? <br />NO IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />• <br />Sunday <br />Monday <br />Tuesday <br />4; <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 />d6'oo <br />x'.36 <br />3 a <br />Sh�J <br />d <br />FOR OFFICE USE ONLY <br />G. HOURS f' O.T. HOURS <br />3a <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 ti injury. See reverse for further information. - <br />S ature of Employee <br />CLIENT. <br />We realize that to transfer one of employees to our <br />payroll requires a settlement. See reverse for further. information. I. <br />hereby c I f 'that -abevf, are correct. <br />Signature of Supervisor <br />TOTAL <br />Hours to nearest quarter hour. T itle .,, Title Date <br />4'. <br />CUSTOMER COPY <br />