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"SELE(TEMP. <br />MEN <br />E M P L 6 Y M E N T S E R V I C E S <br />P.O. Box 71250 • Eugene, OR 97401 <br />PI FAqF PRINT <br />EMPL EE ANE- <br />Ch <br />SOCIAL . SECURITY N��... <br />VMM AAV�� <br />'JOE81ttNAIVIE' AND dR Pb# <br />DIN <br />ASSIGNMENT COMPLETED J� �ETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />[aYES - IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />4tunday <br />Monday <br />Tuesday <br />We' dn e s <br />T hursd ay <br />'Fri "' <br />day <br />Saturday <br />START <br />-STOP <br />'LESS <br />LUNCH <br />REG <br />HOURS <br />OVERTIME <br />HOURS <br />1 . Of <br />0 <br />Hours to nearest quarter hour. <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 re < Iatecl injur 'e, e�V ned to Selectem . <br />, _/po <br />f at the•ti Se ,reverse f r f her ; nfor <br />ure of Em <br />rea t to I a loye a our <br />reguues a settlement. See reverse far further Anfollm 61 1 - <br />hereby certify thaYthe above hours are co rrect " . - <br />vv <br />'TOTAL TOTAL <br />q 0 Title <br />CUSTOMER COPY, <br />.. 7 <br />ire of Supervisor <br />Date <br />