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..SELE(TEM <br />E SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />DI =ACC DDIMT <br />Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />EMPL NAME <br />SOCIAL SECURITY NUMBER <br />CO AN NAME <br />eq T JOBSITE NAME AND /OR PO# ' <br />JALU ENDING DATE <br />l/ <br />ASSIGNMENT COMPLETED ❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF Y_ ES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />-START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />8 <br />FOR.OFFICE USE ONLY <br />G. 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*wo k- related injuries were reported to Selectemp <br />at the ti of injur ee r - or further information. <br />X / �iN"`'1 <br />Signature of Employee - <br />I CLIENT <br />We realize that to transfer.one of Selectemp's employees to our <br />payroll requires a settlement. See reverse for further information. I <br />hereby certify that the above hours are correct. <br />X C <br />Signature of Supervisor <br />TOTAL TOTAL <br />'Hours to nearest quarter hour. , <br />Title Date, <br />CUSTOMER COPY. <br />