LSJE, LLC [EFTA00003056]

• \na \nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: \nax \nDate: \n: \n• - \nEmployee Name: \nCesar \nAddress: \nThone: \nEmergency Contact Form \nStart Date: \n05/04/17 \nDate of Birth: \nE-Mail: \nTitle / Position: Ca,,.- \nMarital Status: Married \nLicense: \n..\nCergency Info• • \nAllergies or Healt \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nPhone: \nPhone: \nIn case of an Emergency, Please contact: \nRelationship \nRelationship \nPhone \nPhone \nThis information is for your safety and the safety of others \nEFTA00003056\n\n--- Page Break ---\n\n• \na \nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: \nax \nDate: \n: \n• - \nEmployee Name: \nCesar \nAddress: \nThone: \nEmergency Contact Form \nStart Date: \n05/04/17 \nDate of Birth: \nE-Mail: \nTitle / Position: Ca,,.- \nMarital Status: Married \nLicense: \n..\nCergency Info• • \nAllergies or Healt \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nPhone: \nPhone: \nIn case of an Emergency, Please contact: \nRelationship \nRelationship \nPhone \nPhone \nThis information is for your safety and the safety of others \nEFTA00003056