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w <br />LESS <br />REG . <br />OVERTIME <br />, FOR OFFICE USE ONLY <br />y _ <br />j <br />START <br />°STOP <br />LUNCH <br />HOURS <br />HOURS <br />a <br />HOURS O.T. HOURS <br />unday <br />,:: E M D L 0'Y M E N T S E R.V. I (E S .- <br />Monday: <br />�: jf <br />S r• <br />D .��� <br />U <br />P:O. Box 71250 • Eugene, OR•_97401 <br />.;. <br />- PLEASE PRINT <br />EMPLOYEE <br />EMPLOYEE NAME <br />1419'k &Z <br />SOCIAL SECURITY.NUMBER <br />r t <br />r t r r^ COMPANY NAME <br />'JOBSI E'NAME AND /OR PO# <br />WEEK ENDING DATE. <br />8 /9// .. <br />D ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE :YOU HAD AN ON THE JOB INJURY THIS WEEK ?. <br />❑ YY 8 IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />IJ NO <br />Tuesday',q '! �v f V I certify that the hours shown,' represent my t9tal hours worked during the <br />week,.and that theywere properly venfietltiythe" "client or "by an auttiorizea <br />representative Also, any related mlunes were reported to Selectemp <br />at the: time of tnfury:Sea reverse for <br />work further informahon r ' <br />Employe <br />CLIENT <br />We'real¢e that to transfer one of e' to t u - <br />/'� payroll,require� /a settlement; See reverse for further information t <br />Fnday ,— ""lam" hereby cerf fy hat the above h re correct <br />AI <br />Saturday �? X < <br />E: ` ' ature of Supervisor C . <br />.� {•T,, I . _ ` TOTAL ' TOTAL <br />Hours to nearest quarter hour. Title - Date <br />CUSTOMER <br />C <br />PY <br />