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- SE L E(TEM P <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 Eugene, OR 97401 <br />DI FACE DDIKIT <br />EMPLOY ENAME <br />�I S� �%�(z -C. <br />SOCIAL SECURITY NUMBER' <br />COMPANY NAME <br />JOBSITE NAME AND /OR PO# <br />WEEK ENDING.DATE <br />❑ ASSIGNMENT COMPLETED �QETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK ?' <br />El YES IF YES, NOTIFY SELECTEMP IMMEDIATELY.. <br />WNO <br />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />oc-0 <br />1 <br />5c). <br />v <br />1450 <br />30 <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 a authorized <br />representative. Also, any work related injuries were reported Selectemp <br />at the t /iiinee of injury: ee reverse for furttheerJi /nfoorr ation. � <br />Signature of Employee <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 ceeft that the above hours are correct. <br />S ture of Supervis r ., {{{���rrr <br />TfJ,TAL TOTAL �j� � X � I �� <br />Hours to nearest quarter hour. <br />Title . Date <br />jSf � <br />Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />