New Search
t aw <br />SELE(TEMP <br />S ..nday <br />LESS <br />LUNCH <br />REG <br />HOURS <br />EMPLOYMENT SERVI(ES: <br />P.O. Box 71250 • Eugene, OR 97401 <br />Monday <br />PI FACE PRINT <br />EMPLOYEE NAME I <br />SOCIAL SECURITY NUMBER <br />COMPANY NAME <br />f. <br />JOBSITF' NAME AND /O O# <br />WEEK ( ENDING DATE <br />ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY'SELECTEMP IMMEDIATELY. <br />NO <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 />G- 0 <br />V V <br />7i� <br />'l '.7U? <br />+ 1� <br />I 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 of injury. See reverse f further information. <br />X <br />Signature of Employee <br />S 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 />herebce tify that the abo hhour ^ are correct: ' <br />X 1G�� <br />Si� re of Supprvisor, <br />TOTAL TOTAL . <br />.. Hours to nearest quarter hour., Title Date <br />CUS O <br />rOMEWCOP.Y <br />