LSJE, LLC [EFTA00003053]

LSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel \nax: \nDate: \n03/19/18 \nEmployee Name: GaSJ Leatham \nAddress: \nPhone: \nTitle / Position: Landscapi"g \nEmergency Contact Form \nStart Date: \nDate of Birth: \nE-Mail: \nMarital Status: Single \nLicense: \n/4 \n4Thergency Informatioi, \nAllergies or Health Concerns: \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nPhone: \nPhone: \nIn case of an Emergency, Please contact: \nName \n),me \nRelationship \nGirlfriend \nPhone \nRelationship \nSister \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003053\n\n--- Page Break ---\n\nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel \nax: \nDate: \n03/19/18 \nEmployee Name: GaSJ Leatham \nAddress: \nPhone: \nTitle / Position: Landscapi"g \nEmergency Contact Form \nStart Date: \nDate of Birth: \nE-Mail: \nMarital Status: Single \nLicense: \n/4 \n4Thergency Informatioi, \nAllergies or Health Concerns: \nBlood Type: \nCurrent Medication: \nDoctor's Name: \nDoctor's Name: \nPhone: \nPhone: \nIn case of an Emergency, Please contact: \nName \n),me \nRelationship \nGirlfriend \nPhone \nRelationship \nSister \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003053