EFTA01342047

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Date: 06/08/18 Emergency Contact Form Employee Name: Cristobal Hidalgo Herrera Address: Boyoni 25C Phone: Position: hTigatio• Celt: Start Date: Date of Birth E-Mail: Marital Status License: r i'mergency information: Blood type unspecified Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: None Phone: Phone: In case of an Emergency, Please contact : Name g.- flame Villglo Herrera Relationship Brother Phone Relationship Phone This Information is for your safety and the safety of others EFTA01342047