Employee Name

_________________________________________
Employee Signature

Social Security Number - -

ASSIGNMENT INFORMATION

Client

Department or Code Supervisor

Week Ending Date (Sunday) Assignment Continued Yes  No

CLIENT APPROVAL & CONTRACT

I am authorized to approve that the regular and overtime hours, recorded above, are correct. I acknowledge that this signed form is a contract with Help Unlimited. We will not offer employment to any Help Unlimited temporary employee without first consulting Help Unlimited about its release fee plan.

X___________________________________________

_____________________________________________
Name                                                              Phone

Two copies to Help Unlimited, one copy for Client, one copy for you