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-SEII(TEMP <br />STOP <br />LESS <br />LUNCH <br />Sunday <br />EMPLOYMENT SE'RVI(ES <br />P.O. Box 71250.• Eugene, OR 97401 <br />Monday <br />DI FACE DDINT <br />EMPLOYEE N E ---,j <br />car ii or f <br />SOCIAL SECURITY NUMBER <br />/} CO ) IfANY.bIAME <br />JOBSITE NAME AND /OR O# <br />— �WEEK�IDING�P�TE <br />R I .l. /./ ` <br />❑ ASSIGNMENT COMPLETED. RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />❑ Y 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 />FOR OFFICE USE ONLY <br />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 Eby an authorized <br />representative. Also, a y work related injuries were repoyted toSelectemp <br />at the time of injur ee reverse for 6c er infor <br />X <br />Signature of Employee f <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />.payroll requiresla settlement. See reverse for further information. I. <br />hereby certify.thaf th bavE hours are correct. <br />Signat re of Supervisor. <br />TOTAL TOTAL iL•�?�g \ ����� �, <br />Hours to nearest quarter hour. . L—Le--, <br />Title Date <br />CUSTOMER C0 PY. <br />