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f Wn day <br />i <br />EMPLOYMENT SERVICES; <br />P.O. Box 71250 • Eugene, OR 97401 Monday, <br />�. '. <br />DI GACF PRINT <br />1 YEE NAME <br />SOCIAL.SECURITYY N <br />COI&AN E <br />'t,. JOBSI,TE NAME AND R PON <br />pgcm ee? ENDJ7z �/ <br />El 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 t <br />Tuesday <br />Wednesday <br />,Thursday <br />t <br />Friday <br />Saturday <br />START <br />STOP <br />LESS' - <br />LUNCH <br />—' REG <br />HOURS <br />OVERTIME <br />HOURS <br />If <br />A *1h <br />10. <br />xxq <br />�F,� <br />-r- <br />'FO R'OFFICE-USE�ONLY r... <br />G. HOURS OT. HOURS <br />a <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 au}horized <br />representative. ' A' so, any word related injuries were reported to Selectemp <br />at the ii Jn .See r verse for her information. <br />Signature of Employee -_ -'y;., -,t• <br />�`• ,CLIENT:'- <br />We.realize,thaj - to transfer one of.Selectern employees to`oor• <br />'.payroll,regmres a, settlerrlenC'See reverse for further mformation'�I' <br />hereby certify that-the above hours are correct <br />Signature of Supervisor - <br />J WL� TOTAL [—✓�A� / �/ / �/ <br />Hours to nearest quarter hour. <br />Title 'Date <br />CUSTOMER COPY <br />