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. <br />o.'" <br />-STOP <br />. <br />Sunday <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 Eugene, OR 97401 <br />Monday <br />DI PACE PRINT <br />EMP YEE NAME <br />SOCIAL SECURITY NUMBER <br />COMPANY NAME <br />JOBSITE NAME AND/6R PO# <br />WEEK 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 />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 />S;:3 <br />6.33 <br />, <br />).0 <br />�; :)3 <br />Gr 3) <br />, .S <br />/L <br />, <br />,3Q TOTAL . <br />` Hours to nearest quarter hour. f t `./ <br />CUSTOMER COPY <br />FOR OFFICE USE ONLY <br />HOURS O.T. HOURS <br />1 <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 cli LIT, by an authorised <br />representative. Also, any work related injuries eported to Selectemp <br />at the time of injury. See reverse for further atton. . <br />X <br />Signature of Em <br />CLIENT <br />We realize than fo. transfer one of Selectemp's employees to our <br />payroll requires a settlement. See reverse for further information. I <br />__�eretiy certi that the above 'ours a correct. <br />f <br />Y c <br />