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' PI _ <br />STOP <br />SELE(TEMP <br />landay <br />OVERTIME <br />HOURS <br />EMPLOYMENT SERVICES <br />RO: Box 71250 • Eugene, OR 97401 <br />Monday <br />'PI FACE PRINT <br />z;30 <br />EMPLOYEE.N f E <br />r� ��1 <br />SOCIAL SECURITY NUMBER <br />C PANY NAME <br />C. o E (-A <br />OB . ITE NAME AND /OR P6#. <br />WE K ENDING DATE, <br />1012 1 <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 />Tuesday <br />Wednesday <br />Thursday <br />Friday <br />Saturday <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 the'time of'ineverse for further information. - - <br />X -. <br />Signature of Empl <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll reg es a settlement. See reverse for further informati _ I <br />hereby c$rt that the above hours are correct. <br />Signature of Supervisor <br />TOTAL TOTAL <br />Hours to nearest quarter hour. <br />Title Date <br />CUS MER COPY <br />START <br />STOP <br />LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />z;30 <br />►( <br />