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" <br />EMPLOYMENT. SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 <br />PI FARF PRINT <br />*day <br />Monday <br />EMPLOYEE NAME <br />VA c— ,i' <br />S CIAL SECURITY NUM R <br />COMPANY NAME <br />(3 <br />JOBSITE NAME AND/O PO# <br />WEEKENDING DATE , <br />❑ ASSIGNMENT COMPLETED +J RETURNING 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 />30 <br />3a <br />h <br />T 3a <br />moo. <br />v <br />FOR OFFICE USE ONLY <br />HOURS O.T. HOURS <br />EMPLOYEE <br />I cerfify 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 injury: See reverse for further nnation. <br />Sign ture of. Employee <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 />7 rebyTerttfy that the,above•h?ur re.corr <br />SignatU a of Superviso <br />" - TOTAL TOTAL <br />: Hours to nearest quarter hour. <br />Title Date <br />CUSTOMER; COPY <br />