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+ .: .. <br />. <br />°.:.EMDL0Y.MENT SEAVIZES <br />P.O. Box 71250 • Eugene, OR 97401 <br />DI GACI? DDIKIT <br />EMPLOYEE AME <br />SO AL SECURITY NUMBER <br />COM NY N E /^ a <br />OBSITE NAME AND /OR P0# <br /># <br />WEEK ENDING DATE' <br />/o -Z 4 <br />❑ ASSIGNMENTCOMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ 'IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />0nday <br />Monday <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 />�Y <br />1 <br />a <br />� <br />8 <br />Z 3D <br />. 3y <br />5 <br />2 .3u <br />3o' <br />fo ;?� <br />3 0 <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. Also, any work related injuries were reported.to Selectemp <br />at t -- ti m e o injury. See reverse for further ormation. <br />X 1 <br />Signature of Employee <br />CLIENT (v/ <br />We realize that to transfer one.of Selectemp's employees to our <br />payrnll�eq rtes .sattlemeut See reverse information. I <br />,Fiereby c? at the above ho are correct. <br />' nature. of Supervisor ' <br />TOTAL TOTAL <br />Hours to'nearest quarter hour. <br />Title Date <br />CUSTOMER COPY <br />