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SELE(TEM <br />EMPLOYMENT SERVICES <br />P.O. Box 71250 • Eugene, OR 97401 , <br />PI FACF PRINT ` <br />�unday <br />Monday <br />, <br />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />EMPLOY <br />ar 4 <br />l/ <br />x SOCIAL'SECURITY NU BER <br />CO PANY NA <br />�W! <br />. r�P <br />JOBSITE NAME'AND /ORZI# . . <br />WEEK ENDIf�C� DATE <br />/ /�� f <br />❑ ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ YES ' IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />O <br />Saturday <br />START <br />STOP <br />LESS <br />LUNCH <br />REO <br />HOURS <br />OVERTIME <br />HOURS <br />06 <br />. N' <br />34 . <br />d <br />FOR OFFICE USE ONLY _ •, <br />,G. HOURS O.T. HOURS <br />EMPLOYEE <br />I certify that the hours shown represent mytotal hours.worked,during the <br />week, and - -that they were properly verrfied l the chant or by an authorized , <br />representahOe.,Also; any work•'related injuries were reported to electem� _.. <br />at the tim�'See se' for further.infn ", <br />5 <br />X l <br />Signature oPEmployee <br />'`CLIENT: ' <br />We realize that to transfer one of Selectemp's employees to our <br />payroll requires a settlement. See reverse for furthe, information.a <br />hereby certify that the above hours are / orrect <br />Signature of Supervisor <br />/-� - -27- >( <br />Date <br />Hours to nearest quarter hour. !J/// —� <br />a.w Title <br />CUSTOMER COPY <br />