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Lj (TEMP <br />- SE� r <br />EMPLOYMENT 51RV.I( -'ES <br />P.O.. Box 71250_ • Eugene, OR 97401 <br />DI CA CC 001KIT <br />y� <br />Sunday <br />Monday <br />EMPLOYEE NAME <br />SOCIAL SECURITY NUMB <br />OMPANY 'AMEN <br />JOBSITE E ND /OR PO# <br />WEg ENDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE'JOB INJURY THIS WEEK? <br />❑ YES F YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />1- <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 or by an authorized <br />represetative. n Also, any work related injuries wer reported to Setectemp <br />at the rim of injury. See reverse • r further infor tion. <br />Signature. ofl mployee <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 ce ify that the,above hours are correct. <br />X <br />ignature of Su ws r - 7 <br />TOTAL - TOTAL <br />:Hours to nearest quarter ho <br />Title Date <br />CUSTOMER COPY <br />i <br />