LSJE, LLC [EFTA00003058]

LSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas. VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 \nDate: \n03/16/1B \nEmployee Name: Justina de Is Cruz \nEmergency Contact Form \nStart Date: \nAddress: \nDate of Birth: \nPhone: \nCad \nE-Mail: \nTitle / Position: Housekeeper \nMarital Status: Marred \nLicense: \nnergency Information: \nv. \nAllergies or Health Concerns: \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nIn case of an Emergency, Please contact: \nName \nFeliz de la Cruz \neaame \nBembenido Gedeno \nRelationship \nPhone: \nPhone: \nHusband \nPhone \nRelationship \nBrother \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003058\n\n--- Page Break ---\n\nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas. VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 \nDate: \n03/16/1B \nEmployee Name: Justina de Is Cruz \nEmergency Contact Form \nStart Date: \nAddress: \nDate of Birth: \nPhone: \nCad \nE-Mail: \nTitle / Position: Housekeeper \nMarital Status: Marred \nLicense: \nnergency Information: \nv. \nAllergies or Health Concerns: \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nIn case of an Emergency, Please contact: \nName \nFeliz de la Cruz \neaame \nBembenido Gedeno \nRelationship \nPhone: \nPhone: \nHusband \nPhone \nRelationship \nBrother \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003058