New Search
S - E(TEMP <br />EL <br />EMPL.OY.MENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401. <br />PI FARF PRINT <br />EMP EE ME <br />C LOA <br />SOCIAL SECURITY 7 <br />ANY ME <br />JOBSITE NAME AND/ . PO# <br />N IAT6-7 <br />❑ ASSIGNMENT COMPLETED ETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <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 />Lei <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 />representaf . A any wor elated injuries were repo Ad to Selectemp <br />at the ti See re r §e for fur informatio <br />X <br />Signature of Employee V , <br />CLIENT, <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requir a settlement. See reverse for further information. I <br />hereby cer f that the above hours are correct. <br />Sign re of vi r <br />� � <br />T TAL T AL <br />Hours to nearest quarter hour. e D <br />. � 1 � Title Date <br />�1l <br />