New Search
= SELECTEMD <br />EMPLOYMENT. SERV.I(ES <br />PO: Box 71250 • Eugene,.OR 97401. <br />PI GACF PRINT <br />EMPLOYEE NAME <br />SOCIAL SECURI UMBER <br />COMPANY NAhdE <br />� <br />JOBSTt NAM AND /OR Plag • . <br />E ENDING DATE <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK ?. <br />t ❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />uL"t. <br />NO. <br />• <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 />6'�0 <br />4�0 <br />to <br />to <br />0 <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 an authorized <br />representative. Also, any work related injuries were reported to Selectemp <br />at the tim of injury. See reverse for further information.. <br />X ' <br />Signature'64Employee <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. 1 <br />hereby certify that the above hours are correct. <br />ture of Suppery or <br />:TOTAL TOTAL <br />Hours to nearest quarter hour. - - <br />- Title ' _. Date. <br />Y Y <br />CUSTOMER COPY <br />