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'EL <br />EMPLOYMENT SERVA <br />P.O. Box 71250 • Eugene, OR 97401 <br />DI CALF DDINT <br />'Sunday <br />Monday <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 />r <br />3o <br />c� <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 were reported to Selectemp <br />at the injury. See reverse for further info <br />X ..� �.., G. �k <br />Signature of 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 information. I <br />hereby c that the above hours are correct <br />X <br />EMPLOY NAM <br />Tau« - <br />'SIY CIAL SECURITY NUMBER <br />�; O�OMPAf�Y NAME _ <br />] <br />JOBSIT NAM ND /0 PO# <br />g EJ ENDING DATE' . <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ ES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />Signature of Supervisor <br />Hours tonearest quarter hour. I, . <br />Title Date <br />35.E <br />CUSTOMER COPY <br />