New Search
SELE(TEMP <br />EMPA0YM.ENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />PI FACE PRINT <br />EMPLOYEE J }� <br />Y /t oi-J lam' l ii*?j <br />SOCIAL SECURITY NUMBER <br />JOMPA� <br />NAME. <br />J B ITE NAME AND AR PO# <br />WEEK ENDING DATE <br />/Z/3 <br />❑ ASSIGNMENT COMPLETED ETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />❑ NO <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 />4 <br />Z <br />w vv <br />;l <br />If <br />1CJ <br />I <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. Iso, any work related injuries were reported to Selectemp <br />at the time jury. See reverse for further information. <br />X <br />Signature of E 657 <br />/aose CLIENT <br />We realize th e transfer one of Selectemp's.employees to our payroll requirpttl reverse for further Information. I <br />IVIHL IVIHL " <br />Hours to nearest quarter hour. <br />Title <br />CUSTOMER COPY F <br />Date <br />