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=,--' <br />rc <br />EMPLOYMENT S "ERVICES <br />P.O. Box 71250 • Eugene, OR 97 <br />PI FASF PRINT <br />MP -YEh E <br />SOCIAL SECURITY <br />C�Otyl A Y NA�V'� <br />JOBSIT / E / NAME AND/OR 0,(2f# <br />WEE END ..P DAT / <br />❑ " ASSIGNMENT COMPLETED RETURNING NEXT WEEK <br />HAVE YOU HAD ANON THE JOB INJURY THIS WEEK? <br />R Y IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Q .nd * ay <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 />? <br />/V <br />PC x <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 At any wor rat injuries were orted to Selectemp <br />at the time I ee a rse for fu r inform <br />X i <br />Signature of Employee <br />CLIENT <br />We realize that to transfer one of Selectemp's employees to our <br />payroll req Tres a settlement. See reverse for further information. I <br />hereby ce ify that the above hours are correct. <br />nature of S pervisor <br />T OTAL TOTAL (=�'� / /" <br />Hours to nearest quarter hour. <br />O Title • - Date <br />CUSTOMER COPY <br />