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ry <br />SELE(TEMP Sunda <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />PI FARE PRINT i <br />EMP OYEE NAME <br />C& y Lu-t <br />SOCIAL SECURITY NUMBER <br />1 COMPANY NAME <br />f t tr <br />JOBSITE NAME 1D/OR PO# <br />E r C, A4 1 L <br />WEEK ENDING DATE <br />- r/v <br />❑ ASSIGNMENT COMPLETED' iO ETURNING 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 />2.. <br />1 <br />g <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 during the <br />week, and that they were properly verified by the client or by an authorized <br />representative. Also, any work related injuries we reported to Selectemp <br />at the lime of injury. See reverse for further info lion. <br />X' .. <br />'Signature of Emplo <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 />Signature of Supervisor <br />TOTAL TOTAL <br />Hours to nearest quarter hour. _ <br />Date <br />Title <br />CUSTOMER COPY <br />