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✓ 4 <br />'. <br />-SELE(TEMP' <br />Sunday <br />LESS <br />LUNCH <br />'REG .OVERTIME <br />HOURS <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />Monday <br />PLEASE PRINT { <br />EMPLOYEE NAME <br />SOCIAL SECURITY NUMBED <br />COMPANY NAME' <br />r <br />JOBSITE NAME_AND /OR PO# <br />WEEK ENDING DATE <br />,P. <br />b Z—ASSIGNMENT COMPLETED. ❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />luesday <br />Wednesday <br />Thursday <br />~ Friday <br />Saturday <br />START' <br />STOP <br />LESS <br />LUNCH <br />'REG .OVERTIME <br />HOURS <br />HOURS <br />Z l' <br />. 3U <br />. el <br />�. 00 <br />,r <br />�;.. <br />04 <br />cot <br />v <br />I ") Voi a i L" W11 weig LID <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 />.representative. Also, any work related injuries were reported to Selectemp <br />at the time of i : ee reverse to further information. <br />X.� . 1 <br />Signature of Employee.. <br />CLIENT <br />We realize-that to transfer'one'of Selectemp's employees to our <br />payroll r quires a settlement. S rev rse foc.further information I <br />hereby c rtlfy he above o s ar rect. <br />X <br />Signature of Supervisor <br />TOT L. .TOTAL <br />Hours 'V6 <br />to nearest quarter hour. <br />V6 Titta ' Date <br />t ' <br />CUSTOMER COPY. ; . <br />