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6nday <br />Monday <br />EMP <br />> <br />v <br />!REG'!. <br />HOURS) <br />,. <br />EM.PL0YME,NT .SIRVI•(ES <br />P.O: =Box 71250 • Eugene, OR 97401. <br />. PI FAt4F PmwrT ^•a <br />6nday <br />Monday <br />Tuesday <br />"Wednesday <br />Thursday <br />r • <br />^•�� Fnday <br />Saturday <br />START <br />EMP <br />OYEE NAME <br />!REG'!. <br />HOURS) <br />in �rl <br />SOCIAL ;SECURITY NUMBER <br />I <br />OMPANY NAM <br />;J SITE, NAME AND /OR eCT <br />WEEK ENDING -DATE <br />ASSIGNMENT COMPLETED RETURNING NEXT WEEK. <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />OYES — IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Tuesday <br />"Wednesday <br />Thursday <br />r • <br />^•�� Fnday <br />Saturday <br />START <br />STOP' <br />LESS <br />LUNCH <br />!REG'!. <br />HOURS) <br />OVERTIME <br />HOURS <br />lyio <br />2 ' ° <br />30 <br />y <br />r <br />a <br />u <br />§ <br />r• <br />FOR OFFICE USE ONLY <br />HOURS O.T. HOUR$ <br />a - <br />EMPLOYEE <br />I certify . that the hours shown represent my total hours worked during the <br />week, and that they were properly verified ¢y the client or by an authorized <br />representative Also any work related mtunes were reported to Selectemp <br />at th of mlury. See revers r further Information <br />� <br />Sgriature of Employee K ,. - t a <br />r . •S �� � r ti <br />We yeah a that to transferaone of Selectemps employees to our x <br />payroll r gwres.a`sefilementi Se erse for further mformahon 1 <br />hereby c rtrf that the b eho <br />���111I� Signa ure of Supervisor - - <br />Hours to nearest quarter hour. / / • , � ` U I f ���" <br />Title Date <br />r' <br />° r CUSTOMER COPY �� <br />