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SELE(TEMP <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene. OR 97401 <br />PI FARF PRINT <br />E1110a NAME <br />SOCIAL SECURITY NUMBER <br />COMPANY NAME <br />t f � <br />JOBSITE NAME AND /OR PO# <br />( i 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 />n-'NO <br />Oday <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 />LP .r <br />, <br />EMPLOYEE COPY <br />7 <br />✓ <br />�. - <br />_ <br />r 7 <br />X <br />FOR OFFICE USE ONLY <br />RIC, 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 oJnjury. See reverse for further information. <br />Signature of Emplo�ae <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 />hereby certify that the above hours are correct. <br />X <br />Signature of Supervisor <br />IVIFiL I L - <br />r I J f <br />Hours to nearest Gu ter hour. Z ' V 1 <br />C- Title <br />Date <br />EMPLOYEE COPY V cz� <br />11 In P <br />SELE(TEI I I Sunday <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />PLFGRF PRINT <br />EMPLOYEE NAME <br />a CAL. i : Vlfi 1 t ,�i � � .� VA <br />SOCIAL SECURITY NUMBER <br />C PANY NAME <br />1 T T -- u-GUtY1s2 <br />JOBSITE NAME AND /OR'00# <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 />LP .r <br />, <br />EMPLOYEE COPY <br />FOR OFFICE USE ONLY <br />REG. HOURS O.T. HOURS <br />EMPLOYEE <br />I certify that the hours shown represent my total hours worked curing 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 for further information. j <br />I k <br />Signature of Employee i y ' <br />f� <br />CLIENT V <br />We realize thaLto transfer one of Selectemp's employees to our <br />payroll requires ,,a settlement. See reverse for further information. I <br />hereby cer tify L iat the above hours aid correct. <br />Signature of Supervisor <br />TOTAL <br />TOTAL <br />�--� <br />Hours to nearest quarter <br />Title � Date <br />, <br />EMPLOYEE COPY <br />