LSJE, LLC [EFTA00003066]

3 \nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tcl: \nFax: \nDate: \n03/25/18 \nEmployee Name: Pierre Jules \nAddress: \nPhone \nTitle / Position: \nEmergency Contact Form \nStart Date: \nDate of Birth \nE-Mail: \nn \nlimergency Information: \nn a \nAllergies or Health Concerns: Bloo0 type unspecified \nBlood Type: \nI \n_ \nCurrent Medication: \nDoctor's Name: \nrVa \nDoctor's Name: \nn/a \nPhone: n/a \nPhone: we \nIn case of an Emergency, Please contact: \nRelationship \nBrother \nPhone \nRelationship \nFriend \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003066\n\n--- Page Break ---\n\n3 \nLSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tcl: \nFax: \nDate: \n03/25/18 \nEmployee Name: Pierre Jules \nAddress: \nPhone \nTitle / Position: \nEmergency Contact Form \nStart Date: \nDate of Birth \nE-Mail: \nn \nlimergency Information: \nn a \nAllergies or Health Concerns: Bloo0 type unspecified \nBlood Type: \nI \n_ \nCurrent Medication: \nDoctor's Name: \nrVa \nDoctor's Name: \nn/a \nPhone: n/a \nPhone: we \nIn case of an Emergency, Please contact: \nRelationship \nBrother \nPhone \nRelationship \nFriend \nPhone \nThis Information is for your safety and the safety of others \nEFTA00003066