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tom+ <br />- ELE(TEMP <br />,: <br />9. <br />.i <br />Sunday <br />EMPLOYMENT SERVICES <br />/ <br />P.O. Box 71250 Eugene, OR 97401 <br />Monday <br />P1 FACF PRINT <br />-PA L', EMPLOYEE NAME <br />/.. <br />SOCIAL SECURITY NUMBER <br />31 ��. <br />CO Y Nljy1E <br />. ' <br />y v% <br />'T JOBSITE'NAME AND /OR PO# <br />WEEK ENDING DATE, <br />�- ( _ -2,0!/ <br />ASSIGNMENT COMPLETED - :� - ?T ` RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />El S IF YES, NOTIFY SELECTEMP IMMEDIATELY.. <br />ENO <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 />/ <br />O <br />Z3v <br />Z 3D <br />� <br />FOR OFFICE USE U1VLY <br />G. HOURS O.T. HOUR <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 W vies were reported to Selectemp <br />at the time of in' Wy..Se ers e for r r information. <br />X <br />Signatur of Emplo ee <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 />e ty that the' urs are correct. . <br />S at , perwso <br />TOTAL TOTAL (� /\ . f <br />Hours to nearest quarter hour. G /U . <br />Title Date <br />CUSTOMER COPY <br />: <br />