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SELE(TEM:P <br />EMPL0YMENI. S( RVI(ES <br />P.O. Box 71250 • Eugene, OR 97401 <br />DI FACE DDIMT <br />� `Q0) —S- LC.E Or <br />!!!!!! 1� lJ V 2 SECURITY NUMBER <br />MPANY NAME <br />V . <br />CO <br />et ry 0 <br />JOBSITE NAME AND )R O O# <br />WEEK ENDING DATE <br />R <br />El ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />Y Sr" IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />�O <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 />vd <br />lXW <br />2 '. LI <br />V2- <br />3U <br />c �� <br />t 2 <br />Hours to nearest quarter hour <br />FOR OFFICE USE ONLY <br />HOURS O.T. HOURS <br />EMPLOYEE <br />I certify that the -hours shown represent my total hours worke during the <br />week, and that they were'properly verified by the clientor by authorized <br />representative. Also, a y work related injuri s were reported Selectemp <br />at the time of in jury, for turf enformaf _ <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 />hereb I fv that the—above hours are c . <br />X <br />Signature of S visor <br />TOTAL TOTAL �— ��-- <br />y� c _ . <br />Title Date <br />7<�1, . <br />4 COPY, <br />