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E M P L O Y M E N T "S' E. R V I ( E* S <br />P.O. Box 71250 • Eugene OR 97401 <br />Runday <br />Monday <br />EM?LOYEE NAME <br />SOCIAL SECURITY NUMBER <br />COMPANY NAME <br />JObSftE.NA <br />MEAND/ <br />0 5e V � <br />VYEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED VRETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />l/ / NO <br />Tuesday <br />• Wednesday <br />Thursday <br />Frida . <br />.�, Saturday <br />START <br />STOP <br />LESS. <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />0A <br />8X <br />L <br />FMOFFICE 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 property verified by the client or by an authorized <br />representative. Also, any work related injuries were reported to Selectemp <br />at thellext-of injury. sea revSI;q for further information. <br />0, <br />turp of <br />-wit. <br />We realize ze I Selectemps errlployees tour <br />furthe mformat . I <br />I U I kk L <br />Hours to nearest quarter hour. <br />Title <br />CUSTOMER COPY..: <br />t tI� &6 hours - arpcohrec.t <br />