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day <br />I <br />„V: <br />EMPLOYMENT SERVICES' <br />P.O. Box 71250 • Eugene, OR 97401 Monday <br />•PI FARF PRINT <br />MP OYEE qAME <br />�. ✓'� S <br />SOCIAL SECURITY NUMBER <br />(f OM NY NAME <br />JO ITE NAME AND /OR PO# <br />'VV EK ENDING DATE <br />❑. ASSIGNMENT COMPLETED TURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE,JOB INJURY THIS WEEK? <br />❑ YES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />0 <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 />V2, <br />" <br />S <br />c <br />o <br />ih <br />FOR OFFICE USE ONLY <br />OURS 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 of inj . See reverse for further information. <br />X <br />Signature of EmplcVee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requ fes a settlement. See reverse for further information. I <br />hereby rGty that the a eve hours are correct. . <br />X ' <br />ignature of Supervisor <br />- - TOTAL TOTAL <br />.Hours to nearest quarter hour. <br />Title _ Date <br />CUSTOMER C PY <br />