LSJE, LLC [EFTA00003067]

LSJE, LLC \n6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: \nDate: \nNI 1/12 \nEmployee Name: Randy Amparo \nAddress: \nPhone: \nTitle / Position: Boat Captain \nimergency Information: \nAllergies or Health Concerns:\nBlood Type: \nEmergency Contact Form \nCell: \nStart Date: \nDate of Birth: \nMarital Status: Single \nLicense: \nCurrent Medication: \nDoctor's Name: \nPhone: \nDoctor's Name: \nPhone: \nIn case of an Emergency, Please contact: \nRelationship \nAlitJame \nRelationship \nFather \nMother \nThis Information is for your safety and the safety of others \nEFTA00003067