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�._.: J a E L.E(T E M P <br />EMDL.0YMENP SERVICES <br />P.O. Box 71250 Eugene, OR 97401 <br />DI CAC= DRIhIT <br />10n day <br />Monday <br />Tuesday <br />I <br />Wednestlay <br />Thursday <br />Friday <br />Saturday <br />EMPLOY NAME <br />V d I <br />SOCIAL SECURITY NUMBER <br />i <br />OMP Y NAME <br />J0,3SITE NAME A /OR PO# <br />G� <br />OVERTIME <br />HOURS <br />` E ENDING DATE <br />O ASSIGNMENT COMPLETED I1-11ETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />O <br />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />to . <br />z.3a <br />i(L <br />-3a <br />L <br />D <br />l <br />FOR OFFICE USE ONLY <br />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. so, any work related injuries were reported to Selec temp <br />at the time of " ry. See reverse for further information. ' <br />X <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />ayroll requires a settlement. See reverse for further Inforation: I <br />by m certify that the above hours are correct.' " <br />X <br />Signature of Supervisor <br />TOTAL TOTAL <br />Hours to nearest quarter hour: 3 7itle� - Date . <br />CUSTOMER COPY <br />