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LE(TE-MP <br />r <br />E- MPL0YMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />PLEASE PRINT <br />EMPLOY NAM n <br />�U VA � E . <br />SCJAL SECURITY NUMBER <br />C PANY NAME <br />JOBSITE NAME AND/OR <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED XJ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />,� NO <br />* Sunday <br />Monday <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <br />START <br />STOP <br />' LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />to <br />, <br />Hours to nearest quarter hour. <br />TOTAL TOTAL <br />O <br />FOR OFFICE USE ONLY <br />G. 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 o ' 'ury. See reverse for further IFftrmation <br />x C {ar <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to'our <br />payroll requlres a settlement. See reverse for further informational <br />e � hat th al�oveiron are correct. <br />Si gp ture of Sup visor <br />Title Date <br />