New Search
EL�E(TEMP <br />"EMD'L0YMENT SERVI <br />[P.O. Box 71250 Eugene, OR 97401 <br />DI FACE PDIMT <br />EMPLOY NAME <br />SO AL SECURITY NUMBER <br />COMPANY NAME <br />G <br />JA y �s I Ph <br />JOBSITE NAME AND/ 61R 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 />* Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturda <br />START <br />STOP <br />LESS <br />LUNCH <br />, HOURS <br />OVERTIME <br />HOURS' <br />-91�;30 <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 work related injuries viejoaportecl to Selectemp <br />.at the time of injury. See reverse for further inf <br />Signature of Ern e <br />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 />Sigrature of Supervisor <br />O TOTAL <br />Hours to nearest quarter hour. V C..• _ V <br />,Title Date <br />9�t G <br />CUSTOMER COPY <br />..,.._....fir:.. __ � . <br />