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�. <br />ELE(TEMP <br />EMPLOYMENT SERVI(ES <br />P.O. Box 71250 • Eugene, OR 97401 <br />PI FAQ;: PRINT <br />EMPLOYE AME <br />a�� e^ in r�� <br />S9 IAL SECURITY NUMB R <br />C � <br />rMPANCNAME G <br />O Q <br />JOBSITE NAME AND/d PO# <br />WEEK ENDING DATE <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 />NO <br />* Sunday <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 />'3o <br />3 (D <br />:3a <br />;�',) <br />�. <br />(� <br />2,'3o <br />3o <br />l� <br />3� <br />3 <br />d <br />Hours to nearest quarter hour. <br />1 111L � ILIML <br />q <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 bythe client or by an authorized <br />representative. Also, any work related injuries were reported to Selectemp. <br />at th ( Injury. See reverse for furth ii formati n. <br />X <br />Signature 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 />hereby certify that the above hours are correct. <br />X� e- <br />Signature of Supervisor <br />Title Dat <br />