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an � MPLOYEE NAME. <br />G y� <br />SOCIAL SECURITY NUMBER <br />CO NY NAME <br />Ct 4 y 0 �, L- oA� <br />f C / JOBSITE NAMt ANDPR PO <br />WEEK ENDIf G DF�TE <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 />*day <br />LESS <br />LUNCH <br />REG <br />HOURS <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />DI CA CC DDINT <br />Monday <br />an � MPLOYEE NAME. <br />G y� <br />SOCIAL SECURITY NUMBER <br />CO NY NAME <br />Ct 4 y 0 �, L- oA� <br />f C / JOBSITE NAMt ANDPR PO <br />WEEK ENDIf G DF�TE <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 />77t77t7t77 <br />FOR OFFICE USE ONLY . <br />HOURS I 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 w rk` related injuries were reported to Selectemp <br />f inju <br />at the time o ry. Seerse for further information.. <br />Signature V p yee . « <br />r, CLIENT. —,, <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requi }es a settlement. See reverse for further information. I <br />� ereby3c rG that I e ab0.a are correct. <br />Hours to nearest quarter hour: •' 24 - <br />Title <br />0. <br />a <br />CUSTOMER COPY <br />Date <br />