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SELE(TEMP <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene; OR 97401 <br />01 FCSF PRINT " <br />unday, <br />Monday <br />G <br />EMPL NAM <br />dr /a <br />LESS <br />LUNCH <br />SOCIAL SE LIRITY N <br />OVERTIME <br />HOURS <br />6. �1PY N mIF <br />j <br />JOBSI AND /O O# <br />Q <br />Q G " DA <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />[I 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 />t 0 <br />/�,ye <br />FOR OFFICE USE O1VLY <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 theymere properly verified by the client or by an authorized <br />repr k related injuries w reported to Selectemp <br />at thrther inf tion. ; <br />X <br />Sign . e <br />CLIENT.: <br />e realize .th to' transfer one. of Select emp's employees to our..r.' <br />payroll uir s a settle ent— Set'revers��fdr further information I <br />he e6: ti at the bove hours are corre� , <br />nature of Su ervi or <br />O AL TOTAL <br />Hours to nearest,quarter hour. . <br />/ Title _ Date <br />- CUSTOMER COPY., <br />