LSJE, LLC
6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: mT

Emergency Contact Form

Date: 04/10/18

Start Date: 05/04/17

Employee Name: James Cesar

Address: a Bt Thames Date of Birth: I

Title / Position: Caioenier Marital Status: Married License: LL

<mergency Info:

Allergies or Health “o

Blood Typo:

Current Medication:

Doctor's Namie:

Doctor's Name:

In case of an Emergency, Please contact :

Relationship Phane

Relationship Phone

This Information is for your safety and the safety of others

EFTAO00003056
