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,. E( <br />*Sunday <br />E.MD(0YMEN SERVICES <br />P.O. Box. 71250 • Eugene, OR 97401 <br />Monday <br />- PLEASE PRINT <br />NAME. 1 <br />aN C EMPLOYEE <br />�,� <br />SOCIAL SECURITY N MBER <br />Xxk --x,� <br />MPANY NAME <br />IOBSITTE , NAME AND/OR PO# <br />� <br />WE <br />K ENDING DATE <br />E ( <br />.zb <br />'11 <br />E ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />ES . IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />P <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 />30 <br />r <br />E ( <br />30 <br />FOR OFFICE USE ONLY <br />G. HOURS O.T. HOURS ' <br />EMPLOYEE <br />I certify that the hours, shown repres my total hours worked during the <br />week and that they were properly v ified by the client or by an authorized <br />re presentativ so, any work re ed injuries were reported to Selectemp <br />at the njury. See revers or further information. <br />Signature Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees, to our <br />payroll requires .a settlement: See reverse for further mformatidn. <br />hereby certify that the above hours are correct. <br />Signature of Supe t <br />.. / T TOTAL — / -'I� . *f _ <br />'Hours to nearest quarter hour. _ ' <br />Title Date <br />.��y y <br />CUSTOMER COPY <br />