LSJE, LLC [EFTA00003064]

L \nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: \n3 \nDate: \n03 19:8 \nEmployee Name: Pd rick L. Cena \nAddress: \nPhone \nTitle / Position: Captain \ni\nmergency Information: \nAllergies or Health Concerns: \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nEmergency Contact Form \nFax \nStart Date: \n02t05/18 \nS.€ x 1 s \nvi 00802 \nDate of Birth: \nCell: \nNo blood type spectfied \nIn case of an Emergency, Please contact : \nName \nante \nE-Mail: \nMarital Status: Divorce \nLicense: \nRelationship \nPhone: \nPhone: \nFather/Stepmother \nPhone \nRelationship \nFnend \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003064\n\n--- Page Break ---\n\nL \nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: \n3 \nDate: \n03 19:8 \nEmployee Name: Pd rick L. Cena \nAddress: \nPhone \nTitle / Position: Captain \ni\nmergency Information: \nAllergies or Health Concerns: \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nEmergency Contact Form \nFax \nStart Date: \n02t05/18 \nS.€ x 1 s \nvi 00802 \nDate of Birth: \nCell: \nNo blood type spectfied \nIn case of an Emergency, Please contact : \nName \nante \nE-Mail: \nMarital Status: Divorce \nLicense: \nRelationship \nPhone: \nPhone: \nFather/Stepmother \nPhone \nRelationship \nFnend \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003064