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START STOP LESS REG OVERTIME - FOR OFFICE USE ONLY <br />LUNCH HOURS HOURS HOURS O.T. HOURS <br />i <br />funday <br />EMPLOYEE NAME <br />OCIAL SECURITY NUMBER <br />COMPANY NAME <br />\' <br />JOBSITE NAME ANWOR POk <br />WEEK ENDING DATE <br />❑ ASSIGNMENT COMPLETED F- -II RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />El NO <br />Monday ' <br />Tuesday <br />Wednesday _ =7 <br />4% .J <br />Thursday <br />Friday <br />Saturday <br />Hours to nearest quarter he <br />EMPLOYEE COPY <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 Seleclemp <br />at the time of injury. See reverse for further information <br />Signature of Employee - , <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 />Title Date <br />-T r J� C&'V 'S u-e <br />�`�. <br />' <br />v� Z <br />C� _ . 3 <br />