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..',.. <br />SELE(TEMP <br />EMPLOYMENT SERVICES <br />P.O. . Box 71250 Eugene, OR 97401 <br />DI CACC DDIRIT. <br />1 4 unday <br />Monday <br />EMPLOYEE NAME <br />Ctivl.� C.G , r - \-e. <br />SOdIAL SECURITY NUMBER <br />COMPANY NAME <br />Q�k R-- <br />JOBSITE NAME AND/OF9PO# <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 />IO <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 />to <br />3� <br />S. <br />'0 <br />73 <br />5 <br />t <br />X� —v- --� <br />Sign dre of Sup rviso <br />Hours to nearest quarterhour. f� <br />V Title � .. � -Date. <br />CUSTOMER COPY <br />'FOR OFFICE USE ONLY <br />HOURS O.T. HOURS <br />EMPLOYEE <br />1 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 injury. See reverse for further information. <br />Signature of Employee <br />CLIENT <br />We realize teat to transfer. one of Selectemp's employees to our <br />ayro equi es a settlement. See reverse for further information. I <br />,Ff rtl y thatl bove -I QVrs> correct. <br />