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', , • <br />ELE(TEMP <br />EMPLOYMENT SERVI(ES• <br />P.O. Box 71250 Eugene, OR 97401 <br />PI FASF PRINT <br />• Sunday <br />Monday <br />Tuesday <br />Wednesday <br />a <br />rThursday <br />EMPL EE NAME 1- <br />S � SE NUMBER <br />r: COMPANY NAME ; <br />JOBSIT NAME AND /OR PO# <br />/gao Roos•yr <br />WEEK ENDING DATE <br />�/ 9/3 /i <br />LI ASSIGNMENT COMPLETED ❑ RETURNING NEXT WEEK <br />HAVE YOU HAD AN ON THE JOB INJURY THIS WEEK? <br />❑ ES IF YES, NOTIFY SELECTEMP IMMEDIATELY. <br />NO <br />Friday <br />Saturday <br />START - <br />STOP <br />'LESS <br />LUNCH <br />REG ' <br />HOURS <br />OVERTIME <br />HOURS <br />`x40 <br />F016FFICE,USE ONLY <br />G. HOURS O.T. HOURS ^ <br />EMPLOYEE <br />I certify that the hours shown repiesent . my total houfs w6rke'd during the <br />week, and teat theywere veri6ed;by the.clientor by an`autlforized- <br />iepresentatigo Also; any work related mlunes were reportftto SelActemp <br />at the time of inluryiSee reverse for further information <br />{ F ` <br />ig ature of <br />We realize that 46transfer one of Selectemp'a emploVeesJo our <br />payroll requires a settlement. See reverse for further mformatioq b <br />herebyce h that th2_g bo, urs are correct.. <br />X <br />, Spsrure of Supervisor <br />TOTAL TOTAL <br />Hours to nearest quarter hour. yol v <br />_ ! Side - Date <br />`. - <br />CUSTOMER COPY <br />